Methadone for managing chronic pain

Approximately 30% of Canadians suffer daily from chronic pain. Patients may be affected differently depending on the intensity, but all chronic pain is debilitating and difficult to treat.

A study carried out by Louise Lamb, a clinician nurse at the Pain Centre of the Montreal University Health Centre (MUHC), and Dr. Yoram Shir, the Director of the Centre, shows that methadone in combination with innovative and high-quality case management can provide relief for many patients. The study results are published in the September issue of Pain Management Nursing.

Methadone is most often associated with drug addiction treatment, yet this opioid is regularly used in hospital settings to relieve acute pain from cancer or arthritis or following an accident.

Because the body metabolizes methadone slowly, intense monitoring is required to avoid toxicity. “As an ambulatory centre, we needed a way to monitor patients effectively after they go home with their prescriptions,” explained Ms. Lamb. The centre implemented an innovative program and then measured its precise impact by following 75 patients over 9 months. Patients, with their family members, began with an education session. They received medication information and treatment guidelines, as well as a diary so they could note any related changes of the pain intensity, and its associated impact on mood and activities. “The pain diary is a very important tool as it allows us to track symptoms. Also, paying attention to bodily changes helps patients become more aware of their physical state,” stated Ms. Lamb.

Regular telephone communication was initiated after the first session to allow nurses, in consultation with a doctor when required, to adjust treatment as required. Out of the 194 phone calls recorded during the study, 44% led to a dosage increase while 11% led to a decrease or cessation. After 9 months, 57% of patients said they were satisfied or very satisfied with the follow-up. “This case management program has a lot of potential, as it does not create additional work for nurses and allows them to follow patients easily and closely without the patient having to travel,” observed Dr. Shir. “This is why the program is now in general use at our centre for all patients on methadone."