title: Methadone and oedema in the palliative care setting: a case report and review of the literature.
abstract: BACKGROUND
  Methadone is a synthetic opioid which is being used with increased frequency in the palliative care setting for management of complex pain. There have been cases published reporting the development of oedema with methadone maintenance therapy but no cases on the association with methadone and peripheral oedema in the palliative care setting. As yet, the underlying mechanisms are unclear.
  
  
  METHODS
  This case report describes a gentleman with ependymoma and difficult-to-control lower back pain and scrotal pain. This pain had failed to respond to other strong opioids. He was prescribed methadone and then subsequently developed bilateral peripheral oedema.
  
  
  RESULTS
  Peripheral oedema resolved following cessation of methadone.
  
  
  CONCLUSIONS
  This highlights an important potential adverse effect of methadone in a society of increased methadone prescription for pain control. The published literature to date is reviewed and possible underlying mechanisms explored.
authors.affiliation: Palliative Medicine Registrar, Department of Palliative Care, Ninewells Hospital, Dundee, UK.
authors.forename: Camilla
authors.initials: C
authors.lastname: Dawson
authors.forename: Fiona
authors.initials: F
authors.lastname: Paterson
authors.forename: Fiona
authors.initials: F
authors.lastname: McFatter
authors.forename: Deans
authors.initials: D
authors.lastname: Buchanan
mesh_terms: D000328:Adult; D015760:Alfentanil / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001416:Back Pain / Q000188:drug therapy*; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D004487:Edema / Q000139:chemically induced*; D004806:Ependymoma / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D060186:Infusions, Spinal; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D010166:Palliative Care; D012611:Scrotum; D013125:Spinal Neoplasms / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D015760:Alfentanil; D008691:Methadone
keywords: Methadone; oedema; pain; palliative