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Treating Pain in Patients Receiving Methadone Maintenance for Opioid Dependence

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Handbook of Methadone Prescribing and Buprenorphine Therapy

Abstract

The treatment of acute and chronic pain in patients receiving methadone for the treatment of opioid dependence represents a clinical challenge for generalists and specialists alike. Pain can often serve as a trigger to relapse to illicit opioid use highlighting the need to assess and address pain complaints in this population. Increasingly, patients receiving methadone maintenance have a history of abusing prescription opioids (JAMA 289(18):2370–8, 2003), and patients report pain as their initial impetus to seek opioids resulting in a loss of control over their use and addiction once the severity of the pain complaint had lessened. Likewise, patients may use their methadone provided for maintenance treatment of addiction as an analgesic thereby using a medication in a way that it was not initially prescribed (Pain Medicine 9(3):359–64, 2008). In addition, clinicians often have misconceptions about the role that methadone maintenance plays in analgesia based on an incomplete understanding of the pharmacology of the medication and the role of physiologic tolerance (Ann Intern Med 144(2):127–34, 2006). The situation is compounded by the fact that pain complaints and comorbid psychiatric disorders that decrease effective coping skills and increase pain perception (e.g., depression), are prevalent in patients receiving methadone for the treatment of opioid dependence (JAMA 289(18):2370–8, 2003). In this chapter we will address common misconceptions regarding the treatment of pain in opioid-dependent patients receiving methadone and discuss strategies to address the management of acute and chronic pain in patients receiving methadone.

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Author information

Authors and Affiliations

  1. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA

    Daniel P. Alford MD, MPH

  2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Declan T. Barry PhD

  3. Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, 208093, New Haven, CT, 06520-8093, USA

    David A. Fiellin MD

Authors
  1. Daniel P. Alford MD, MPH
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  2. Declan T. Barry PhD
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  3. David A. Fiellin MD
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Corresponding author

Correspondence to David A. Fiellin MD .

Editor information

Editors and Affiliations

  1. , Dept of Pain Med and Palliative Care, Beth Israel Medical Center, Union Square East 10, New York, 10003, New York, USA

    Ricardo A. Cruciani

  2. , Dept of Pain Mgmt and Palliative Care, Beth Israel Medical Center, East 17th Street 350, New York, 10003, New York, USA

    Helena Knotkova

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Alford, D.P., Barry, D.T., Fiellin, D.A. (2013). Treating Pain in Patients Receiving Methadone Maintenance for Opioid Dependence. In: Cruciani, R., Knotkova, H. (eds) Handbook of Methadone Prescribing and Buprenorphine Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6974-2_3

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  • DOI: https://doi.org/10.1007/978-1-4614-6974-2_3

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  • Publisher Name: Springer, New York, NY

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  • Online ISBN: 978-1-4614-6974-2

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