Palliative and Supportive Care

Review Articles

Consensus guideline on parenteral methadone use in pain and palliative care

Lauren Shaiovaa1 c1, Ann Bergera2, Craig D. Blindermana3, Eduardo Brueraa4, Mellar P. Davisa5, Susan Derbya6, Charles Inturrisia7, Jill Kalmana8, Davendra Mehtaa9, Marco Pappagalloa10 and Eugene Perlova11

a1 Pain and Palliative Care Physician, Bethesda, Maryland

a2 Palliative Care Service, Department of Medicine, Massachusetts General Hospital and the Harvard Medical School Center for Palliative Care, Boston, Massachusetts

a3 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas

a4 Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, Cleveland, Ohio

a5 Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York

a6 Weill Cornell Medical College, New York, New York

a7 Cardiovascular Institute, Mount Sinai Medical Center, New York, New York

a8 Section of Cardiac Electrophysiology, Mount Sinai Hospital and School of Medicine, New York, New York

a9 Mount Sinai School of Medicine, New York, New York

a10 Visiting Nurse Service of New York Hospice Care, New York, New York

a11 Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York


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.

(Received September 21 2007)

(Accepted December 02 2007)


c1 Address correspondence and reprint requests to: Lauren Shaiova, Department of Pain Medicine and Palliative Care, Metropolitan Hospital Center, Health and Hospital Corporation of New York City; 1901 First Ave. New York, NY 10029. E-mail: or