Pain Management Q&A by Dr. Helm

Can methadone be used for severe back pain, or is it strictly used for people who have a drug problem?

Answer:

Methadone is used both for treating pain and for treating narcotic addiction. In order to prescribe it to treat addiction, the physician must have special certification from the DEA (Drug Enforcement Administration). However, any licensed physician may prescribe methadone to treat pain.

Methadone is a very effective drug for treating chronic pain. However, it has unique characteristics that separate it from the other pain pills and, which led the FDA to issue a statement regarding methadone on November 27, 2006. The FDA noted that the pain relief from methadone lasts about 4-8 hours, but the drug's elimination from the body is much slower, taking up to a week. This means that if you rapidly increase your methadone dose, the methadone can accumulate in the body with the risk of stopping breathing. Further, methadone is associated with abnormalities in heart rhythm, potentially leading to death. In addition, the metabolism of methadone in the liver is very complex, and interactions with the metabolism of other drugs can lead to changes in the blood level of both the methadone and the other drugs. Finally, methadone is secreted in breast milk and can be passed on to nursing infants. The FDA did not prevent physicians from prescribing methadone for treating pain, but did request that physicians prescribing the drug be familiar with these issues and also follow a "start low, go slow" approach to dosing methadone.

Thank you for your question.


Last Editorial Review: 12/14/2006



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