Consensus guideline on parenteral methadone use in pain and palliative care

• Published in: Palliative & supportive care Vol. 6; no. 2; pp. 165 - 176
• Main Authors: Shaiova, Lauren, Berger, Ann, Blinderman, Craig D., Bruera, Eduardo, Davis, Mellar P., Derby, Susan, Inturrisi, Charles, Kalman, Jill, Mehta, Davendra, Pappagallo, Marco, Perlov, Eugene
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.06.2008
• Subjects: Addictions; Analgesics; Anesthesia; Catheters; Chronic illnesses; Chronic pain; Drug dosages; Enzymes; Fentanyl; Hospice Care - methods; Hospice Care - standards; Humans; Metabolism; Metabolites; Methadone; Methadone - therapeutic use; Morphine; Narcotics; Pain - drug therapy; Pain management; Palliative care; Palliative Care - methods; Palliative Care - standards; Patients; Physicians; Practice Guidelines as Topic; Toxicity; Palliative care; Opioid; Analgesia; Pain; Analgesics; Intravenous methadone
• ISSN: 1478-9515; 1478-9523
• DOI: 10.1017/S1478951508000254

Once used only as third-line therapy for chronic pain management, methadone is now being used as first- and second-line therapy in palliative care. The risks and stigma associated with methadone use are known, but difficulties with dosing methadone and lack of an established conversion protocol from other opiates have limited the access for patient populations who could potentially benefit from this medication. For palliative care patients, the benefits of methadone can far outweigh its risks. This article provides an overview and specific recommendations on the use of parenteral methadone in pain and palliative care, with a focus on the transition from hospital to home/hospice care. The goal of this consensus guideline is to assist clinicians who are providing chronic pain management in acute care hospital and nonhospital settings (i.e., hospice, long-term care facilities, and community) for patients with life-limiting illnesses, where the goals of care are focused on comfort (i.e., palliative care). The recommendations in this article intend to promote a standard of care involving the use of intravenous methadone with the aim of reaching a broader population of patients for whom this drug would provide important benefits.