Oral methadone for chronic noncancer pain: a systematic literature review of reasons for administration, prescription patterns, effectiveness, and side effects.
Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario, Canada. Clinical Journal of Pain
(Impact Factor: 2.53).
To assess the indications, prescription patterns, effectiveness, and side effects of oral methadone for the treatment of chronic noncancer pain.
We conducted searches of several electronic databases, textbooks and reference lists for controlled or uncontrolled studies in humans. Effectiveness was assessed using a dichotomous classification of "meaningful" versus "nonmeaningful" outcomes.
Twenty-one papers (1 small randomized trial, 13 case reports, and 7 case series) involving 545 patients with multiple noncancer pain conditions were included. In half of the patients, no specific diagnosis was reported. Methadone was administered primarily when previous opioid treatment was ineffective or produced intolerable side effects. Starting dose ranged from 0.2 to 80 mg/day and maximum dose ranged from 20 to 930 mg/day. Pain outcomes were meaningful in 59% of the patients in the uncontrolled studies. The randomized trial demonstrated a statistically significant improvement in pain for methadone (20 mg/day) compared to placebo. Side effects were considered minor.
Oral methadone is used for various noncancer pain syndromes, at different settings and with no prescription pattern that could be identifiable. Starting, maintenance, and maximum doses showed great variability. The figure of 59% effectiveness of methadone should be interpreted very cautiously, as it seems overrated due to the poor quality of the uncontrolled studies and their tendency to report positive results. The utilization of oral methadone for noncancer pain is based on primarily uncontrolled literature. Well-designed controlled trials may provide more accurate information on the drug's efficiency in pain syndromes and in particular neuropathic pain.
Available from: Jerome Schofferman
- "Methadone has gained in popularity as an analgesic because it is highly effective, has high biological availability, no known active metabolites, no known neurotoxicity, is inexpensive , and may have less opioid-induced hyperalgesia (OIH) than alternatives   . On the other hand, methadone has a high number of potential drug interactions, and it is more difficult to initiate therapy. "
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ABSTRACT: The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
The Spine Journal 01/2008; 8(1):185-94. DOI:10.1016/j.spinee.2007.10.020 · 2.43 Impact Factor
Available from: Laverne Snow
- "Methadone may pose patient safety concerns because of its highly variable half life, 16–100 h, and variable potency with chronic opiate users. Additionally, methadone may be more likely to cause harm than other pain medications due to physician inexperience titrating a safe, effective dose; lack of clear evidence for appropriate use; and the risk of delayed overdose  . "
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ABSTRACT: Healthcare safety and quality surveillance is increasingly conducted by public health agencies. We describe a biomedical informatics method that uses multiple public health data sources to perform surveillance of methadone-related adverse drug events. Data from Utah medical examiner records, vital statistics, emergency department encounter administrative data and a database of controlled substances prescriptions are used to examine trends in state-wide adverse events related to methadone. From 1997 to 2004, population-adjusted methadone prescriptions increased 727%, with evidence to suggest the rise in the methadone prescription rate is for treatment of pain, not addiction therapy. During the same period of time, population adjusted, accidental methadone-related deaths in medical examiner data increased 1770%. Population adjusted methadone-related emergency department encounters rose 612% from 1997 to 2003. Our results suggest that the increase in methadone prescription rates from 1997 to 2004 was accompanied by a concurrent increase in methadone-related morbidity and mortality. Although patient data is not linked between data sources, our results demonstrate that utilizing multiple public health data sources captures more cases and provides more clinical detail than individual data sources alone. Our approach is a successful biomedical informatics approach for surveillance of adverse events and utilizes widely available public health data sources, as well as an emerging source of public health data, controlled substance prescription registries.
Journal of Biomedical Informatics 09/2007; 40(4):382-9. DOI:10.1016/j.jbi.2006.10.004 · 2.19 Impact Factor
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ABSTRACT: The simulation of elastic waves in inhomogeneous media is
important in many applications such as seismic survey, acoustic well
logging, and other nondestructive evaluation applications. The perfectly
matched layers (PML) has been introduced by Berenger (see Computational
Physics, vol.114, p.185-200, 1994) as a material absorbing boundary
condition (ABC) for electromagnetic waves. We prove that a fictitious
elastodynamic material half-space exists that will absorb an incident
wave for all angles and all frequencies. We show two and three
dimensional computer simulations of the PML for the linearised equations
of elastodynamics. A comparison with Liao's (1984) ABC is also given
Antennas and Propagation Society International Symposium, 1996. AP-S. Digest; 08/1996
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