Review Articles

Consensus guideline on parenteral methadone use in pain and palliative care

Lauren Shaiova^a1 c1, Ann Berger^a2, Craig D. Blinderman^a3, Eduardo Bruera^a4, Mellar P. Davis^a5, Susan Derby^a6, Charles Inturrisi^a7, Jill Kalman^a8, Davendra Mehta^a9, Marco Pappagallo^a10 and Eugene Perlov^a11

^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

ABSTRACT

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)

KEYWORDS

• Analgesia;
• Palliative care;
• Pain;
• Analgesics;
• Opioid;
• Intravenous methadone

Correspondence:

^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: lauren.shaiova@nychhc.org or lshaiova@gmail.com