Can You Use Methadone for Back Pain?

  • Medical Author:
    Standiford Helm II, MD

    Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Ask the experts

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

Doctor's response

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.

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Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCE:

"Treatment of persistent pain in older adults"
UpToDate.com

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Last Editorial Review: 7/17/2017

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