Methadone is safe for treating hospitalized patients with severe pain
Child; Female; Hospitalization; Humans; Male; Adult; Analgesics; Aged; Middle Aged; Analgesia; adolescent; Preschool; infant; Administration; Oral; retrospective studies; Pain/drug therapy; Pain Measurement/drug effects; Epidural; Methadone/administration & dosage/adverse effects/therapeutic use; Monitoring; Opioid/administration & dosage/adverse effects/therapeutic use; Physiologic
PURPOSE: Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients. Clinical features: Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization. CONCLUSION: Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some in-patient populations.
2001
Shir Y; Rosen G; Zeldin A; Davidson EM
Canadian Journal Of Anaesthesia
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1007/bf03020377" target="_blank" rel="noreferrer">10.1007/bf03020377</a>
Oral methadone for the treatment of severe pain in hospitalized children: a report of five cases
Child; Female; Male; Analgesics; Parents; Treatment Outcome; Analgesia; Preschool; Administration; Oral; Neoplasms/therapy; Human; Case Report; Opioid/therapeutic use; Patient-Controlled; Wounds; Hospitalization; Palliative Care/methods; Burns/therapy; Methadone/therapeutic use; Nonpenetrating/therapy; Osteopetrosis/therapy; Pain/physiopathology
OBJECTIVE: Pain relief is still inadequate in many hospitalized patients, especially children in whom suboptimal use of analgesic drugs is still common. In the past 2 years, oral methadone has been used extensively in our institution for treating children with persistent pain from cancer, burns, or trauma who were capable of oral intake and whose pain was not relieved by nonopioid medications. SETTING: Tertiary university hospital. PATIENTS: Of the 70 children treated thus far with oral methadone, five are described in the present report. MAIN OUTCOME MEASURE: Pain relief, acceptability, and side effects of oral methadone in children with pain. RESULTS: Treatment with oral methadone (0.1% in 10% glucose, dose range of 0.2-0.6 mg/kg/day) for time periods of up to 6 weeks resulted in a rapid onset and stable pain relief, with no major side effects. No adverse responses were encountered after discontinuation of treatment. In three of the children, a parent-controlled analgesia regimen was successfully employed. CONCLUSIONS: Oral methadone can be recommended for babies and children who have severe pain that is not alleviated by nonopioid medications and who are capable of oral intake.
1998
Shir Y; Shenkman Z; Shavelson V; Davidson EM; Rosen G
Clinical Journal Of Pain
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00002508-199812000-00013" target="_blank" rel="noreferrer">10.1097/00002508-199812000-00013</a>