Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study |
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| Authors: | Altier N Dion D Boulanger A Choinière M |
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| Affiliation: | 1. Centre des Grands Brûlés, Hôtel-Dieu du Centre Hospitalier de l''Université de Montréal and Department of Anesthesiology, Faculty of Medecine, University of Montréal, Montréal, Québec, Canada, H2W IT8;2. Clinique Anti-Douleur, Hôtel-Dieu du Centre Hospitalier de l''Université de Montréal and Department of Anesthesiology Faculty of Medecine, University of Montreal, Montréal, Québec, Canada, H2W IT8;1. Department of Neurosurgery, Taipei City Hospital, Zhongxiao Branch, Taiwan;2. Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan;3. Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei, Taiwan;4. Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei, Taiwan;5. Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan;6. Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA;7. Aristea Translational Medicine, Park City, UT, USA;8. Department of Neurosurgery, Case Western Reserve University, School of Medicine, Cleveland, OH, USA;9. Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan;1. Department of Translational Bioscience, Human Health Therapeutics, National Research Council Canada, 1200 Montreal Road, Ottawa, Ontario, Canada K1A 0R6;2. Université de Nice Sophia Antipolis, IPMC, Sophia Antipolis, F-06560, France;3. CNRS, IPMC, Sophia Antipolis, F-06560, France;1. Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Laboratory of Membrane Excitability and Disease Mount Sinai School of Medicine, 1425 Madison Avenue, ICAHN 9-26, 28, New York, NY 10029, United States;3. Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States;4. Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, LA, United States;5. Department of Biomedical Sciences, Marquette University, Milwaukee, WI 53201-1881, United States |
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| Abstract: | Methadone is used increasingly as a second-line opioid in the management of cancer pain refractory to conventional opioids. Recent case studies suggest that its use as an analgesic could be extended to non-cancer pain, especially neuropathic pain. The present case study reports, for the first time, the efficacy of methadone in a burn patient experiencing neuropathic pain in his healed wounds. The patient sustained extensive (55% total body surface area) chemical burns and developed chronic burning sensations, particularly in the lower limbs where skin grafting had been performed. Conventional pharmacotherapies against neuropathic pain were attempted to control pain for over 5 years. The agents used included long- and short-acting opioids, amitriptyline, clonazepam, and gabapentin, but they all failed to relieve the pain. When methadone (5 mg every 12 h) was introduced, it significantly alleviated the patient's pain within a few days of administration. The patient has now been taking methadone (15 mg every 12 h) for 10 months and reports that the opioid caused 70% pain relief and a 55% amelioration in his quality of life. Although these results are based on a case report, they suggest that a switch to methadone might be useful in some burn patients who have developed chronic neuropathic pain unrelieved by conventional pharmacotherapies. Methadone, however, needs to be titrated with vigilance and thus should be administered by a physician experienced with its use in the treatment of chronic pain. |
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