Journal of pain & palliative care pharmacotherapy
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Methadone is a synthetic opioid that is effective for the relief of moderate-to-severe pain and for the treatment of opioid dependence. The pharmacokinetics of methadone differ from those of morphine in that methadone has a higher bioavailability, a much longer half-life, and is hepatically metabolized by cytochrome P450 enzymes. The pharmacokinetics of methadone are variable and an understanding of the factors that impact the onset, magnitude, and duration of analgesia is required to optimize therapy. ⋯ AMEDLINE search was performed to identify literature published between 1966 and May 2005 relevant to the pharmacokinetics of methadone. These publications were reviewed and the literature summarized regarding unique and clinically important elements of methadone disposition including its absorption profile, distribution, and metabolism/excretion. General dosing guidelines, dosage conversions from other opioids and pharmacokinetic issues in special populations are discussed.
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J Pain Palliat Care Pharmacother · Jan 2005
Model policy for the use of controlled substances for the treatment of pain.
The Federation of State Medical Boards of the United States published Model Guideline for the Use of Controlled Substances in the Management of Pain in 1998 and expanded it to this Model Policy in October 2004. The Model Policy is designed to communicate to licensees that the state medical board views pain management to be important and integral to the practice of medicine; that opioid analgesics may be necessary for the relief of pain; that the use of opioids for other than legitimate medical purposes poses a threat to the individual and society; that physicians have a responsibility to minimize the potential for the abuse and diversion of controlled substances; and that physicians will not be sanctioned solely for prescribing opioid analgesics for legitimate medical purposes.
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The use of steroids administered into the epidural space to manage low back pain is described in a manner that a clinician might use to explain this intervention to a patient or care-giver.