Nurses Perspectives on Low-Dose Methadone for Pain in Nursing Homes: Semi-structured Interviews

Background: Chronic pain is prevalent in nursing homes, yet safe and effective long-acting opioid options are limited. Studies suggest that low-dose methadone (LDM) may be an ideal alternative. However, its use in nursing homes remains rare and perspectives from nursing staff on its practical benefits and challenges are underreported. Objectives: To explore nurses' perspectives on LDM for pain in nursing home residents and assess potential benefits and barriers to its adoption. Design: A qualitative study employing semi-structured interviews and a modified phenomenological approach. Setting/Subjects: Nurses who administered LDM (<10 mg/day) as the primary opioid for pain in the past three years in Hawaii and British Columbia nursing homes. Measurements: Semi-structured interviews were conducted via Zoom™ using a standardized interview guide. Interviews were recorded, transcribed verbatim, and analyzed using a qualitative description approach. Data collection continued until thematic saturation was reached. Results: Of the 11 nurse participants, most reported that LDM was effective in managing pain without major side effects, even in cases where other opioids had failed, and observed improvements in resident behavior. Four key themes emerged: initial hesitancy and the role of education, effectiveness in pain control, preferable side effect profile, and pros and cons of administration. Participants noted that LDM's long-acting nature and liquid formulation were particularly beneficial in nursing home settings. Additionally, the use of LDM appeared to alleviate their workload by improving resident cooperation and reducing the need for frequent medication administration. Conclusions: LDM is effective and well-tolerated for pain management in nursing home residents, with minimal side effects and added benefits for resident behavior and nurse satisfaction. These findings support the need for further studies to assess LDM's utility in nursing home settings.