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Methadone in Pain Management: A Systematic Review
Verina Hanna1, Helen Senderovich2
1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
The Journal of Pain
|June 30, 2020
Summary
Methadone shows analgesic effectiveness for various pain types, including cancer and neuropathic pain, with similar side effects and lower costs compared to other drugs. More research is needed to confirm its role in pain management.
Area of Science:
- Pain Management
- Pharmacology
- Evidence-Based Medicine
Background:
- Pharmacological pain management presents challenges due to variable effectiveness and adverse effects.
- Methadone is gaining attention for managing both cancer and non-cancer pain.
- Randomized controlled trials (RCTs) are crucial for evaluating analgesic efficacy.
Purpose of the Study:
- To conduct a narrative review of RCTs on methadone's effectiveness for pain management.
- To compare methadone's analgesic effectiveness, side effects, and cost against control drugs.
- To identify gaps in current research regarding methadone's role in pain relief.
Main Methods:
- Searched PubMed, Medline, Embase, and Google Scholar for eligible RCTs.
- Assessed the methodologic quality of included studies.
- Included 40 RCTs, primarily comparing methadone to morphine or fentanyl.
Main Results:
- Methadone demonstrated analgesic effectiveness across diverse pain types: postprocedural, cancer-related, nociceptive, and neuropathic.
- Effectiveness in specific conditions may vary by procedure or cancer type.
- Side effects were comparable to control drugs, and methadone offered a cost benefit.
Conclusions:
- Methadone shows promise as an analgesic, potentially as monotherapy or adjunctive treatment, especially for patients with renal impairment.
- Further high-quality RCTs are necessary to solidify its therapeutic role.
- Standardization of outcome measures is needed for pooled analysis and definitive conclusions.
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