title: Use of Methadone as an Adjuvant Medication to Low-Dose Opioids for Neuropathic Pain in the Frail Elderly: A Case Series.
abstract: Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally. Furthermore, dosing of neuropathic medications is limited by renal function, which is often impaired in the elderly due to both normal aging and renal disease. Methadone is an opioid analgesic that is effective in the treatment of neuropathic pain, is excreted by the bowels, is highly lipophilic, and can be administered through the oral, buccal, or sublingual routes. We present three cases highlighting the use of low-dose adjuvant methadone to manage complex neuropathic pain in the frail elderly.
authors.affiliation: 1 Baycrest Health Sciences , Toronto, Ontario, Canada .|2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Tammy
authors.initials: T
authors.lastname: Vu Bach
authors.affiliation: 3 Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pan
authors.affiliation: 1 Baycrest Health Sciences , Toronto, Ontario, Canada .|3 Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Anne
authors.initials: A
authors.lastname: Kirstein
authors.affiliation: 1 Baycrest Health Sciences , Toronto, Ontario, Canada .|4 Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Cindy Joanne
authors.initials: CJ
authors.lastname: Grief
authors.affiliation: 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .|5 Freeman Centre for the Advancement of Palliative Care, North York General Hospital , Toronto, Ontario, Canada .
authors.forename: Daphna
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000368:Aged; D000700:Analgesics; D000701:Analgesics, Opioid; D016330:Frail Elderly; D006801:Humans; D008691:Methadone; D009437:Neuralgia
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D008691:Methadone
keywords: chronic pain; frail elderly; geriatrics; methadone; neuropathic pain; renal impairment