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Related Experiment Videos

Conversion from intrathecal morphine to oral methadone.

Rodolfo Gebhardt1, Michelle A O Kinney

  • 1Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

Regional Anesthesia and Pain Medicine
|May 23, 2002
PubMed
Summary

This case study details converting high-dose intrathecal morphine to oral methadone for severe back pain. The methadone to morphine conversion ratio was higher than anticipated, offering new insights for pain management.

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Area of Science:

  • Pain Management
  • Pharmacology
  • Oncology

Background:

  • Methadone is a cost-effective analgesic with variable equianalgesic ratios to other opioids.
  • Intrathecal (IT) drug delivery is used for refractory pain.
  • Accurate equianalgesic dosing is critical for safe and effective opioid conversion.

Observation:

  • A 37-year-old male with a history of recurrent L5 plasmacytoma and spinal fusion experienced escalating back pain.
  • An infected intrathecal drug delivery system required removal, necessitating a change in analgesia.
  • Pain management was transitioned from IT morphine to IV morphine, then to oral methadone.

Findings:

  • This is the first reported case of converting high-dose IT morphine to oral methadone.
  • The observed IT morphine to oral methadone equianalgesic ratio exceeded standard estimations.

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  • This suggests a potentially higher methadone requirement than predicted by conventional tables.

    • Implications:

    • Clinicians should exercise caution when converting from high-dose IT morphine to oral methadone.
    • Further research is needed to establish accurate equianalgesic ratios for this specific conversion.
    • This case highlights the complexity of opioid conversion in patients with refractory pain and implanted devices.