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Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomized controlled crossover trial

Pain Research Institute, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool

John Bridson

Pain Research Institute, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool and National Refractory Angina Centre, Cardiothoracic Centre, Liverpool

Tim P Nash

Pain Research Institute, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool and Walton Centre for Neurology and Neurosurgery, Liverpool

John B Miles

Pain Research Institute, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool

Sarah White

St Georges Hospital Medical School, London

Matthew K Makin

Pain Research Institute, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool and North East Wales NHS Trust and Nightingale House Hospice, Wrexham

The analgesic effectiveness and adverse effect incidence of a daily dose of 10 or 20 mg of oral methadone were evaluated in 18 patients with a diverse range of chronic neuropathic pain syndromes, who had all responded poorly to traditional analgesic regimens. Analgesia was seen after each dose of methadone. As compared with placebo, the 20 mg daily dose (given as 10 mg bd) resulted in statistically significant (P=0.013–0.020) improvements in patient Visual Analogue Scale ratings of maximum pain intensity, average pain intensity and pain relief, recorded at the same time daily. The analgesic effects extended over 48 hours, as shown by statistically significant (P=0.013–0.020) improvements in all three outcomes on the rest days instituted between each daily dose. Analgesic effects (lowered maximum pain intensity and increased pain relief, on the day of dosing only) were also seen when the lower daily dose of 10 mg methadone (given as 5 mg bd) was used, but these failed to reach statistical significance (P=0.064 and 0.065, respectively). Interpatient analysis showed that the analgesic effects were not restricted to any particular type of neuropathic pain. Patient compliance was high throughout the trial. One patient withdrew during the 10 mg and six during the 20 mg methadone treatment periods. This is the first double-blind randomized controlled trial to demonstrate that methadone has an analgesic effect in neuropathic pain.

Key Words: methadone • neuropathic pain • pain relief • randomized control trial

Palliative Medicine, Vol. 17, No. 7, 576-587 (2003)
DOI: 10.1191/0269216303pm815oa


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