title: Using methadone to treat opioid-induced hyperalgesia and refractory pain.
abstract: A patient was treated for several years with high doses of opioids for malignant pain. During a recent hospitalization, the patient's pain remained uncontrolled despite escalating doses of various opioids. We suspected that this patient suffered from the clinical phenomenon of opioid-induced hyperalgesia (OIH). The patient was then rotated from her other opioids to methadone, and her pain was adequately controlled within several days. Methadone, because of its NMDA antagonist properties, offers an effective treatment for OIH. The use of methadone for analgesia is complex and should be undertaken only by practitioners who have appropriate experience.
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Axelrod
authors.forename: Barbara
authors.initials: B
authors.lastname: Reville
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy* / Q000209:etiology; D016903:Drug Monitoring; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced / Q000188:drug therapy*; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone