Methadone analgesia.

elkpark · Jun 11, 2015

The people I've seen on methadone for chronic pain usually take it BID and also have a short-acting opioid ordered (on a prn basis) for breakthrough pain.

softrbreeze · Jun 11, 2015

Methadone is excellent pain control for most people as long as they are not opoid-naÃ¯ve. It can be given prn for breakthrough also but must be carefully monitored with daily visits during the 1st few days, regardless of where the patient resides. Adjuvants are fine to use.

toomuchbaloney · Jun 11, 2015

Methadone can be a wonderful addition to the POC for hospice patients with uncontrolled pain.

It should be ordered and managed by a physician and pharmacist experienced in the use of methadone.

Good luck.

midazoslam · Jun 11, 2015

Thanks for your input, everyone. It's great to get other people's perspectives. In terms of monitoring, I'd imagine it would relate to adverse effects such as respiratory depression and CNS changes?

If I remember correctly, methadone is great for uncontrolled neuropathic and bone pain?

I'm only learning so forgive my ignorance. Just started a palliative care course :)

MunoRN, RN · Jun 11, 2015

Methadone is an opioid receptor agonist so your monitoring is going to be the same as other opioids.

midazoslam · Jun 11, 2015

I knew that - I was just testing you :cat:

Thanks again. I have a case of Brain drain.

Cheers.

jdub6 · Jun 14, 2015

In my experience, the trend is for methadone to be treated a bit differently and more carefully than other opioids. For example, there is variability in peak and total length of effect, and also the theory is that there are differences in both the tolerance to and the time to peak repository effect vs analgesic effect. It is also theorized to be a"better" drug for opioid-tolerant pts who have exhausted other options and/or who have uncontrolled bone or nerve pain. it can also be helpful for those requiring extreme amounts of other narcotics or exhibiting symptoms of addiction. However, it must be used carefully. Oh, and in addition to the funny quirks I mentioned above I do believe it has been shown to cause higher risk of sudden death and prolonged qt, especially at high doses. That said it can be a miracle drug for some hospice pts in pain and also can help with addiction.

guest538567 · Jun 14, 2015

It should also be noted that methadone represents roughly 2% of opioid prescriptions yet accounts for a third of all overdose deaths. This is due to the unique pharmacokinetics of the drug and is the primary reason I am a prescriber that is apprehensive to use it despite its low cost and effectiveness as a long acting analgesic.

Prescription Painkiller Overdoses | Vital Signs

midazoslam · Jun 14, 2015

Thanks guys, you're very informative.

I was aware of QT elongation and sudden death. I can see why some prescribers are reluctant to recommend it for their patients.

I've only seen it used once, and that was oral mixture for someone with a heroin addiction. It was accidentally given to another client by a nurse, and luckily the adverse effects weren't catastrophic - the other patient just had a reeeeeeeeally good sleep.

I actually listened to a fabulous podcast by Professor David Castle (University of Melbourne), who was discussing the potential for positive effects from cannabinoids and the research going into the treatment of chronic pain and nausea secondary to cancer. There is so much potential in it!

DLS_PMHNP, MSN, RN, NP · Jun 15, 2015

Only certain providers will prescribe it; those with specialized training or experience. I have seen excellent results, especially when other opioids are not effective.

heron, ASN, RN · Jun 15, 2015

Me, too. Not a good drug for establishing initial control. The long half life makes it hard to titrate, but once the baseline need is established with something like morphine, you can convert to an equi-analgesic dose of methadone and tweak from there. It's a great maintenance tool along with something short-acting like morphine or oxycodone available for breakthrough pain.