Rediscovery of Methadone to Improve Outcomes in Pain Management

Clinically, methadone is most known for its use in the treatment of opioid maintenance therapy. However, methadone's pharmacological profile makes it an excellent analgesic that can enhance acute and chronic pain management. It is a potent it-receptor agonist with a longer elimination half-life than most clinically used opioids. In addition, methadone inhibits serotonin and norepinephrine uptake, and it is an N-methyl-D-aspartate antagonist. These distinct analgesic pathways mediate hyperalgesic, allodynic, and neuropathic pain. Its unique analgesic properties provide several essential benefits in perioperative use, neuropathic pain, cancer, and noncancer pain. Despite these proven clinical utilities, methadone has not been used widely to treat acute and chronic pain in opioid naive patients. This article describes the unique pharmacology of methadone and provides emerging evidence to support its application in acute and chronic pain management. Pain management options and guidelines for surgical patients on methadone are discussed as well. (C) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Automated summary

Methadone is not only used in opioid maintenance therapy but also serves as an excellent analgesic that enhances acute and chronic pain management. Its unique pharmacological profile provides important benefits in perioperative use, neuropathic pain, cancer, and noncancer pain.