Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine.

J Res Med Sci. 2012 Feb; 17(2): 143-7
Shahraki AD, Jabalameli M, Ghaedi S

Appropriate pain management is needed during the post-partum hospitalization period for preventing cesarean section (CS) related complications. Protocols of post-partum pain management should be planned based on the facilities of each center or region. The aim of current study was to compare the analgesic efficacy of oral methadone and intra muscular (IM) pethidine which the latter was routinely used in our center in post cesarean pain treatment.In this prospective double-blind clinical trial, women who were candidate for cesarean section were selected and randomized into two groups. All patients routinely received a single IM pethidine dose (50 mg) after CS in the recovery room. One group of patients received 0.7 mg/kg pethidine every 6 hour IM, and another group received 0.07 mg/kg oral methadone every 6 hour. Severity of pain assessed using visual analogue scale (VAS) score in 6, 12, 18 and 24 hour after surgery.Pain severity in methadone group at 6, 12, 18 and 24 hour post operation were 6.4 ± 0.9, 3.4 ± 0.8, 1.9 ± 1.1, 0.5 ± 0.5 (p < 0.05) and for patients in pethidine group were 6.6 ± 0.8, 3.4 ± 0.9, 2.1 ± 1.0 and 0.5 ± 0.5 (p < 0.05), respectively (Mean ± SD). Between groups differences in each follow up time were not statistically significant. There was no difference between groups in terms of complications and supplementary analgesic use.Considering the similar analgesic effects of methadone and pethidine, satisfaction of patients and nursing system with methadone use and the cost benefit of methadone, it can be recommended to use methadone for post operative pain relieving. HubMed – Methadone

Is opioid-induced hyperalgesia reversible? A study on active and former opioid addicts and drug naïve controls.

J Opioid Manag. 2012 Nov; 8(6): 343-349
Treister R, Eisenberg E, Lawental E, Pud D

OBJECTIVE: Hyperalgesia has been observed in active opioid addicts (OAs). The aim of this study was to explore whether opioid-induced hyperalgesia (OIH) is a reversible phenomenon. DESIGN: Observational study. PARTICIPANTS: The study included the following three groups of male subjects: 1) active addicts on heroin or methadone (OAs, n = 50); 2) former opioid addicts with at least 5 months of abstinence from drug use (FOAs, n = 43); and 3) drug naïve controls (C, n = 50). INTERVENTIONS: All subjects were exposed to the cold pressor test (1°C). MAIN OUTCOME MEASURES: Cold pain threshold (latency to pain onset, seconds) and cold pain tolerance (latency to pain intolerability, seconds). RESULTS: Mean ± standard deviation (SD) pain thresholds were 10.8 ± 7.7, 6.9 ± 3.9, and 6.8 ± 3.5 seconds for the OAs, FOAs, and C groups, respectively (analysis of variance [ANOVA], p = 0.002, 95% CI = 7.5-9.2). Mean ± SD pain tolerance levels were 30 ± 36.2, 64 ± 58.1, and 56.4 ± 51.4 seconds for the OAs, FOAs, and C groups, respectively (ANOVA, p < 0.001, 95% CI = 43-60.4). Post hoc analyses revealed significant changes between the OAs and the other two groups for both variables. CONCLUSIONS: It is suggested that altered pain perception in OAs is a reversible phenomenon that may require a long period of abstinence to reset, rather than being an individual long-term stable trait. HubMed – Methadone

Rethinking Methadone for The Management of Chronic Pain.

J Opioid Manag. 2012 Sep; 8(5): 271-272
Reisfield GM, Sloan PA

HubMed – Methadone

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol.

Subst Abuse Treat Prev Policy. 2012 Dec 23; 7(1): 48
Janssen P, Demorest LC, Kelly A, Thiessen P, Abrahams R

ABSTRACT: BACKGROUND: The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns. METHODS: We randomly assigned chemically dependent pregnant women at BC Women’s Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care. RESULTS: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant. CONCLUSIONS: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns.Clinical Trial Registrationhttp: www.clinicaltrials.gov registry: W05-0041.
HubMed – Methadone

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