Highlights
- •Methadone may be a powerful analgesic for cancer-related and noncancer-related pain.
- •It is an inexpensive option with side effects similar to those of other opioids.
- •Expertise with its pharmacokinetics should be sought before prescribing to patients.
- •Future trials should standardize reported outcomes to allow for meta-analysis.
Abstract
Adequate analgesia can be challenging, as pharmacological options are not necessarily
effective for all types of pain and are associated with adverse effects. Methadone
is increasingly being considered in the management of both cancer-related and noncancer-related
pain. The purpose of this article is to provide a narrative review of all available
randomized controlled trials (RCTs) investigating the effectiveness of methadone in
the management of pain, in relation to a comparison drug. The primary outcome was
analgesic effectiveness, and the secondary outcomes were side effects and cost. A
search of PubMed, Medline, Embase, and Google Scholar databases was conducted to identify
eligible RCTs and methodologic quality was assessed. A total of 40 RCTs were included
in this review. The majority compared methadone to morphine or fentanyl. Analgesic
effectiveness of methadone was demonstrated in different types of pain, including
postprocedural, cancer-related, nociceptive, and neuropathic pain. The evidence demonstrates
that the use of methadone in postprocedural pain and in cancer-related pain may be
dependent on the procedure and cancer type, respectively. Side effects experienced
were generally similar to the comparison drug, and lower cost was a benefit to using
methadone. Methadone may also be useful as an adjunctive analgesic for adequate pain
control, as well as in patients with renal impairment. Additional high-quality, large-scale
RCT evidence is needed to establish its role as monotherapy or as an adjunctive medication.
Future research should also aim to standardize reported outcomes for measuring analgesic
effectiveness to permit for pooled analysis across studies.
Perspective
This article presents a systematic review, which includes a summary of published RCTs
investigating the effectiveness of methadone in the management of pain. This is important
for determining its analgesic utility and for identifying gaps in existing knowledge.
Key words
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Article info
Publication history
Published online: June 26, 2020
Footnotes
Disclosures: There are no conflicts of interest.
There are no sources of funding for this work.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
