Treating Pain in Patients Receiving Methadone Maintenance for Opioid Dependence

  • Daniel P. Alford
  • Declan T. Barry
  • David A. Fiellin
Chapter

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.

Keywords

Toxicity Depression Morphine Acetaminophen Tricyclic 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Daniel P. Alford
    • 1
  • Declan T. Barry
    • 2
  • David A. Fiellin
    • 3
  1. 1.Section of General Internal MedicineBoston University School of MedicineBostonUSA
  2. 2.Department of PsychiatryYale University School of MedicineNew HavenUSA
  3. 3.Department of Internal MedicineYale University School of MedicineNew HavenUSA

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