Methadone for Pain Management

Red pain flaring up in the lower back

Commonly known as a medication used to treat opioid use disorder, methadone is also used for pain management.

Below, we’ll explain what class of drug methadone belongs to, how it works, its side effects, and information about methadone for pain management.  

What is Methadone?

Methadone is a strong synthetic opioid, with similar effects to morphine and fentanyl. Synthetic means it is made in a laboratory as opposed to growing naturally, like opioids such as those derived from the opium poppy. It was invented by German doctors during World War II to treat people with extreme pain.

Methadone is a Schedule II substance, under the Controlled Substances Act. With its potent pain relieving properties, methadone can be prescribed by physicians with a Drug Enforcement Agency (DEA) waiver for two main uses, described below.

It comes in tablet, powder, and liquid forms and can be used orally, intramuscularly, as well as intravenously. Methadone works by changing the way the brain and body respond to pain, thus relieving the pain. It also blocks the euphoric effects of other opioid drugs, like codeine, heroin, morphine, and oxycodone.

How is Methadone Used?

Methadone has two main uses:

  1. Medication-assisted treatment (MAT): methadone is approved by the Food and Drug Administration (FDA) as a cornerstone treatment for individuals with opioid use disorder. This is also called medication-assisted recovery.
  2. Pain management: to treat individuals with chronic pain, like patients with a cancer diagnosis, or those recovering from surgery, when around-the-clock pain relief is needed. 

Methadone must be prescribed by a doctor or a specific treatment program. 

What is Pain Management?

Everybody experiences pain at some point in their lives, whether they broke a bone, or stubbed their toe. Chronic pain, however, affects 1 in 5 American adults causing severe disability, not to mention lost work, social, relational, and mental health impacts. 

Most pain can be managed by over-the-counter pain relievers, like Tylenol, or ibuprofen. However, acute, or chronic pain (meaning severe pain, or long-lasting pain) may need medical intervention.

Unmanaged chronic pain can cause difficulties with recovery from surgery, physical effects, and negative impacts on mental health. That’s where pain management can help. 

Pain management helps to evaluate, diagnose, and find effective ways to treat different types of pain. Depending on the pain and conditions, it may take several specialist doctors, like a neurologist, anesthesiologist, and oncologist to coordinate pain management.

A therapist or psychologist can also support patients dealing with the mental health effects of chronic pain. 

There are several types of pain management:

  • Medication: this might include non-narcotic, such as anti-inflammatories, steroids, and opioid drugs
  • Nonpharmacological interventions: treatments like physical therapy, exercise, massage, acupuncture, and relaxation can relieve pain

Depending on the type of pain and condition, your doctor may choose one, or a combination of approaches to manage pain levels. Typically, clinicians approach pain management from a non-opioid perspective first, changing to an opioid if the pain continues to be uncontrolled.

Using Methadone for Pain Management

Methadone is being increasingly used for its pain relieving properties and has been shown to reduce opioid tolerance and act on the central nervous system to relieve pain. While morphine has been the standard medication for the management of pain, one study showed methadone to be superior in reducing more severe pain.

Methadone may also be suitable, according to the British Medical Journal, for individuals whose pain is uncontrolled and individuals who cannot tolerate morphine. 

However, as methadone is a potent opioid, with complex properties, it requires careful dosing and monitoring. It also can have adverse effects and interact with other medications. That said, doctors say it is a safe and effective use for chronic pain.

Your physician should also provide the opioid overdose reversal drug, naloxone (brand name Narcan), as a safety precaution for anyone taking an opioid. You can also obtain naloxone from most pharmacies without a prescription. 

What Are The Side Effects of Methadone?

Methadone is associated with several side effects, including:

  • Upset stomach
  • Weight gain
  • Itchy skin
  • Restlessness
  • Sweating
  • Dry mouth
  • Mood changes
  • Vision problems
  • Sleep changes
  • Sexual problems
  • Constipation
  • Slowed breathing
  • Flushing
  • Headache
  • Appetite changes
  • Stomach pain

If you, or your loved one, experiences more serious side effects, like:

  • Difficulty breathing
  • Fainting or lightheadedness
  • Chest pain
  • Slowed heart rate
  • Drowsiness and difficulty staying awake
  • Confusion
  • Hives or rash
  • Hallucinations
  • Swollen lips tongue, throat, or face, 
  • Seizures,
  • Respiratory arrest (stopped breathing)
  • Pinpoint pupil

Go to the nearest emergency room, or call 911, as these are signs of an opioid overdose. 

The risks associated with methadone use, include tolerance, dependence, overdose, drug interactions, and potential withdrawal effects if stopped too quickly.

Additionally, methadone cannot be taken by people with heart, lung, brain, liver, bladder, pancreas, drugs for which you take sedatives, or thyroid conditions. 

Can You Take Other Pain Meds With Methadone?

Your physician is the most appropriate person to advise you on drug interactions when taking methadone.

However, known drugs that can affect methadone include other opioids, drugs that impact breathing, or drugs that affect certain chemicals in the brain, like SSRIs. 

Should I Take Methadone for Pain Relief?

There is no straightforward answer to this question because it depends on each individual, their health, and their circumstances.

It’s important to talk to your doctor about the pain you experience and the effects it has on your life. You might want to consider:

  • Does this pain affect your ability to live your life?
  • How the pain affects your work
  • What is the impact of your pain on the enjoyment of your relationships, or perhaps your ability to play with your children?
  • The mental health impacts of pain: is it making you more withdrawn or depressed?
  • Are there things you’re no longer able to do because of your pain?

These are all questions that a pain management practitioner will ask you, but you might want to take an honest look at these questions first to get a true picture of how your pain is impacting your life.

The other thing to bear in mind is that all medications have some side effects, it’s up to you and your doctor to weigh those effects with the ways in which pain is affecting your quality of life.

You may also want to ask loved ones about their point of view as they may make observations you may not. 

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-994-1867Who Answers? today to learn about your treatment options.

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