• Camilla Dawson, Fiona Paterson, Fiona McFatter, and Deans Buchanan.
• Palliative Medicine Registrar, Department of Palliative Care, Ninewells Hospital, Dundee, UK.
• Scot Med J. 2014 May 1; 59 (2): e11-3.

IntroductionMethadone is a synthetic opioid which is being used with increased frequency in the palliative care setting for management of complex pain. There have been cases published reporting the development of oedema with methadone maintenance therapy but no cases on the association with methadone and peripheral oedema in the palliative care setting. As yet, the underlying mechanisms are unclear.Case PresentationThis case report describes a gentleman with ependymoma and difficult-to-control lower back pain and scrotal pain. This pain had failed to respond to other strong opioids. He was prescribed methadone and then subsequently developed bilateral peripheral oedema.Case ManagementPeripheral oedema resolved following cessation of methadone.ConclusionsThis highlights an important potential adverse effect of methadone in a society of increased methadone prescription for pain control. The published literature to date is reviewed and possible underlying mechanisms explored.

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