Pain management strategies for patients on methadone maintenance therapy: A systematic review of the literature

Mel Clark Taveros, Elizabeth J. Chuang

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Context Prescription opioid and heroin abuse has increased substantially in recent years. Enrolment on opioid agonist therapy programmes is consequently increasing as well. As a result of these trends, more patients who present with acute pain secondary to a malignancy are also on chronic methadone maintenance therapy (MMT) for substance abuse. This combination of diagnoses presents a pain management challenge for palliative care providers. Objectives This paper aims to gather and review the available medical literature pertaining to the use of opioid analgesia in methadonemaintained patients. Methods The authors searched PubMED, PsychINFO, EMBASE, Clinical Key, the Cochrane Library and CINAHL from their inception to May 2015 for relevant articles. All articles that discuss opioid therapy in adult patients on methadone maintenance for opioid addiction with cancer or advanced illness were included. Data were extracted and study quality was rated independently by the authors. Results Our searches resulted in 680 hits. Of those, only 7 met inclusion criteria for the study. Most of the studies favoured the use of methadone either in scheduled divided doses every 4-8 hours or by continuous intravenous infusion. The overall strength of the evidence was poor, consisting mainly of case series, case reports and 1 single-centre retrospective cohort study lacking a comparison group. Conclusions Treating MMT-maintained patients with methadone for analgesia may be preferable to using other opioid analgesics. However, there are many systems barriers that may make this approach challenging and the evidence favouring methadone over other opioid analgesics is weak.

Original languageEnglish (US)
Pages (from-to)383-389
Number of pages7
JournalBMJ Supportive and Palliative Care
Volume7
Issue number4
DOIs
StatePublished - Dec 1 2017

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Methadone
Pain Management
Opioid Analgesics
Analgesia
Therapeutics
Heroin Dependence
Acute Pain
Palliative Care
Intravenous Infusions
Libraries
Substance-Related Disorders
Prescriptions
Neoplasms
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Oncology(nursing)
  • Medical–Surgical

Cite this

Pain management strategies for patients on methadone maintenance therapy : A systematic review of the literature. / Taveros, Mel Clark; Chuang, Elizabeth J.

In: BMJ Supportive and Palliative Care, Vol. 7, No. 4, 01.12.2017, p. 383-389.

Research output: Contribution to journalReview article

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