Chronic pain: cancer: methadone

Methadone is roughly equianalgesic with morphine, but has a long and variable half-time (13-100 hours). It is an NMDA antagonist in addition to an opioid agonist. It appears to reduce post-operative opioid consumption in patients on chronic opioid therapy.

A recent Cochrane Database Systematic Review supports the assertion that methadone offers equal analgesic potency with morphine, but notes that methadone has no additional advantages for treating neuropathic pain and that its use for several days may lead to development of delayed adverse consequences.


Keyword history




  1. Antje Gottschalk, Marcel E Durieux, Edward C Nemergut Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth. Analg.: 2011, 112(1);218-23
  2. A B Nicholson Methadone for cancer pain. Cochrane Database Syst Rev: 2007, (4);CD003971]
  3. Evan D Kharasch Intraoperative methadone: rediscovery, reappraisal, and reinvigoration? Anesth. Analg.: 2011, 112(1);13-6
  4. G K Gourlay, P R Wilson, C J Glynn Methadone produces prolonged postoperative analgesia. Br Med J (Clin Res Ed): 1982, 284(6316);630-1
  5. G K Gourlay, P R Wilson, C J Glynn Pharmacodynamics and pharmacokinetics of methadone during the perioperative period. Anesthesiology: 1982, 57(6);458-67
  6. G K Gourlay, R J Willis, P R Wilson Postoperative pain control with methadone: influence of supplementary methadone doses and blood concentration–response relationships. Anesthesiology: 1984, 61(1);19-26
  7. G K Gourlay, R J Willis, J Lamberty A double-blind comparison of the efficacy of methadone and morphine in postoperative pain control. Anesthesiology: 1986, 64(3);322-7