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Can levorphanol be used like methadone for intractable refractory pain?
1Palliative Care Institute of Southeast LA, Covington, Louisiana 70433, USA. jmcnulty@palliativecare-la.org
Journal of Palliative Medicine
|May 3, 2007
Summary
Levorphanol offers significant pain relief for patients unresponsive to other opioids. This study suggests levorphanol
Area of Science:
- Palliative Care
- Pain Management
- Pharmacology
Background:
- Levorphanol's unique analgesic properties may stem from dual action on opioid and NMDA receptors.
- Its efficacy at lower doses suggests a mechanism distinct from pure agonist opioids.
Purpose of the Study:
- To evaluate levorphanol's effectiveness in managing refractory pain syndromes.
- To compare levorphanol's role to other opioids, including methadone, in palliative and hospice care.
Main Methods:
- A case series design was employed.
- Patients with chronic nonmalignant pain and severe refractory pain in hospice were treated with oral levorphanol.
- Treatment was initiated when other opioids, including methadone, provided inadequate pain relief.
Main Results:
- Out of 31 patients treated with levorphanol, 16 (52%) reported excellent pain relief and 7 (22%) reported fair relief.
- A total response rate of 74% was observed in patients with refractory pain.
- The study period spanned 5 years within a single palliative medicine practice.
Conclusions:
- Levorphanol demonstrates a significant role in treating pain syndromes resistant to other opioid analgesics.
- The observed pain relief patterns are comparable to those reported for methadone.
- Levorphanol may serve as an alternative for managing pain poorly controlled by other pure agonist opioids.
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