Analgesic requirements for patients on methadone

Consider non-opioid analgesics (NSAIDs or paracetamol). Where parenteral analgesics are required, consider ketorolac (Toradol®), or tramadol (Tramal®).

Management of acute pain in hospital for patients on MMT

  • Patients on methadone who are experiencing acute pain in hospital often receive inadequate doses of opiates for serious pain.

  • Analgesia should be provided to patients in MMT in the same way as for other patients. This includes the use of injectable and patient controlled analgesia.

  • Because of their tolerance of opioids, patients taking methadone frequently require larger doses of opioid analgesia for adequate pain relief.

  • Partial agonists such as buprenorphine should be avoided as they may precipitate withdrawal symptoms.
There is evidence of cross tolerance between methadone and anaesthetic agents and so patients on methadone may require higher doses of anaesthetic agents in the event of dental or surgical procedures.

Management of patients with chronic pain

Patients needing methadone for ongoing management of chronic pain need a comprehensive management plan. It is recommended that specialist advice be sought regarding such patients.