Use of Methadone for the Treatment of Diabetic Neuropathy

Hays, Lewis S.; Reid, Coleen; Doran, Michelle; Geary, Karyn

doi:10.2337/diacare.28.2.485

Cited by 15 publications

(9 citation statements)

References 10 publications

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“…Methadone has been used in children for various pain entities, including acute procedure-related pain for burn care (Williams, Sarginson & Ratcliffe, 1998), other types of non-cancer pain in hospitalized children (Shir, Shenkman, Shavelson, Davidson, & Rosen, 1998), and for severe cancer-related pain (Sabatowski, Kasper, & Radbruch, 2002), chronic cancer-related pain (Martinson et al, 1982; Rowbotham et al, 2003), and cancer-related end of life care (Sirkia, Hovi, Pouttu, & Saarinen-Pihkala, 1998). In adults, methadone is also used for neuropathic pain entities: phantom limb pain (Bergmans, Snijdelaar, Katz, & Crul, 2002), diabetic neuropathy (Hays, Reid, Doran, & Geary, 2005), intractable neuropathic non-cancer pain (Altier, Dion, Boulanger, & Choiniere, 2005; Moulin, Palma, Watling, & Schulz, 2005), neuropathic pain related to burns (Altier, Dion, Boulanger, & Choiniere, 2001), and cancer-related neuropathic pain (Makin & Ellershaw, 1998). …”

Section: Current Directions At St Judementioning

confidence: 99%

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Anghelescu¹,

Oakes²,

Hankins³

2011

Pain Management Nursing

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A significant proportion of patients report long-term pain that is 5 or above on a 0 to 10 intensity scale after limb-sparing surgery for malignancies of the long bones. Patients experience several distinct types of pain after limb-sparing surgery, which constitute a complex clinical entity of pain post-limb sparing surgery. This retrospective study examined 26 years of experience in a pediatric institution (1981 through 2007) in pain management as far as 6 months after limb-sparing surgery and reviewed the historical evolution of pain interventions. One hundred and fifty patients underwent 151 limb-salvage surgeries for bone cancer of the extremities in this series. Pain treatment increased progressively in complexity. Therapies included opioids, nonsteroidal antiinflammatory drugs, acetaminophen-opioid combinations, postoperative continuous epidural infusion, anticonvulsants and tricyclic antidepressants for neuropathic pain, local anesthetic wound catheters, and continuous peripheral nerve block catheters. Management of pain after limb-sparing surgery has evolved over the 26 years of this review. It presently relies on multiple "layers" of pharmacological and nonpharmacological strategies to address the complex mixed nociceptive and neuropathic mechanisms of pain in this patient population.

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Section: Current Directions At St Judementioning

confidence: 99%

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Anghelescu¹,

Oakes²,

Hankins³

2011

Pain Management Nursing

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“…In general, there is extensive experience with methadone for pain management in the adult population, 1,18 and specifically for cancer pain, 1,2,5,6,19–21 chronic noncancer pain, 22 intractable neuropathic noncancer pain, 23 and diabetic neuropathy. 24 In adults, methadone has been reported to be effective for various types of neuropathic pain, including phantom limb pain, 25 diabetic neuropathy, 24 intractable neuropathic noncancer pain, 23,26 burns, 27 and neuropathic cancer pain. 28 …”

Section: Introductionmentioning

confidence: 99%

Methadone use in children and young adults at a cancer center: A retrospective study

Anghelescu¹,

Faughnan²,

Hankins³

et al. 2011

J of Opioid Management

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Objective To augment the literature on methadone applications in pediatric oncology, the authors reviewed the use of methadone at a pediatric cancer center over a 5-year period. Design and setting Forty-one patients received methadone for inpatient or outpatient pain management. The authors retrospectively reviewed their demographic characteristics, diagnoses, type of pain (nociceptive, neuropathic, or mixed) and causes of pain, and the indications, dose regimens, adverse effects, and outcomes of methadone treatment. Results There were four types of clinical uses for methadone in 41 patients (10 patients had two): nociceptive pain unresponsive to other opioids (17 patients, 33.3 percent), neuropathic pain (20 patients, 39.2 percent), facilitation of weaning from opioids (11 patients, 21.6 percent), and end-of-life pain management (3 patients, 5.9 percent). The mean age of the 24 males (58.5 percent) and 17 females (41.5 percent) at the start of treatment was 15.7 years (range, 0.6–23 years). The most common diagnoses were leukemia (n = 10, 24.4 percent), osteosarcoma (n = 7, 17.0 percent), and rhabdomyosarcoma (n = 5, 12.2 percent). The causes of pain were bone marrow transplant (n = 13, 31.7 percent), amputation (n = 6, 14.6 percent), chemotherapy (n = 5, 12.2 percent), tumor (n = 5, 12.2 percent), limb-sparing surgery (n = 4, 9.8 percent), and other (n = 8, 19.5 percent). Efficacy was assessed at the end (or after 6 months) of methadone treatment. For many patients (43.1 percent), methadone showed efficacy in achieving the purpose for which it was prescribed, including reduction of nociceptive or neuropathic pain and prevention of opioid withdrawal. Sedation was the most common side effect (24.4 percent). Conclusions Methadone was effective for pediatric patients with neuropathic pain or nociceptive pain unresponsive to other opioids, and it effectively prevented opioid withdrawal.

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“…In patients with mild pain, tricyclic antidepressants or anticonvulsant medications are helpful, but this is not the case with moderate or severe pain. Hays et al [53 ] advocate methadone in such cases, believing it to be the best opioid because of its antagonism to N-methyl-D-aspartate receptors, inhibition of norepinephrine and serotonin reuptake, trimodal metabolism/excretion (liver, gut, and renal), lack of active metabolites, lipophilia, and low cost. Recently, acetyl-L-carnitine has been found to reduce pain, especially in patients with type 2 diabetes with suboptimal hyperglycemic control; it also appeared to promote nerve regeneration and repair of A delta and C fibers as assessed on sural nerve biopsy [54].…”

Section: Treatmentmentioning

confidence: 97%