Methadone: an effective, safe drug of first choice for pain management in frail older adults.
OBJECTIVE
Frail older adults have a high prevalence of chronic pain with major effects on function and quality of life. Many analgesics, including opioids, have adverse effects on older adults with multiple co-morbidities. Methadone has been increasingly used for analgesia in the last 10 years. However, a number of adverse events such as sleep-disordered breathing, methadone-induced torsades de pointes arrhythmias, as well as the "addiction stigma," have made people reluctant to use this medication.


METHODS
This article uses examples of five cases of pain in frail older adults living in a skilled nursing facility.


RESULTS
Safe and effective use of methadone is illustrated with these cases. The pharmacology of methadone in frail elders is reviewed to demonstrate the specific benefits of the drug in older adults and how adverse events can be minimized.


CONCLUSIONS
Methadone is an excellent choice for pain in frail older adults.
Gallagher
Romayne
R
Division of Residential Care, Department of Community and Family Medicine, Providence Health Care, Canada. rgallagher@providencehealth.bc.ca
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid; D008691:Methadone