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If your doctor has brought up prescribing methadone for pain, you might have questions — especially if you associate this medication with opioid use disorder (OUD) treatment.
Methadone is an opioid that doctors can prescribe two different ways: to manage pain or as part of medications for opioid use disorder (MOUD). MOUD is sometimes called medication-assisted treatment (MAT).
Read on to learn how methadone works for pain, when doctors consider prescribing it, what risks it can have, and how doctors monitor this treatment.
Methadone is a long-acting opioid medication. Doctors may use this drug to treat persistent moderate to severe pain when other treatments don’t provide enough relief. It can also help treat opioid use disorder.
Methadone attaches to opioid receptors in the brain and changes how the nervous system feels pain. In people with OUD, it can reduce withdrawal symptoms and cravings to use opioids.
Methadone’s pain-relieving effect may last six to eight hours, so it’s usually taken on a set schedule. Its half-life, or how long it stays active in the body overall, is often much longer and varies widely from person to person.
The mismatch between the time the medication relieves pain and its half-life is one reason methadone requires careful dosing management. The pain relief effect can wear off before the drug has fully left the body, which makes it risky to take an extra dose too soon.
Most opioids, including morphine, oxycodone, hydromorphone, and fentanyl, relieve pain mainly by acting on opioid receptors in the brain and spinal cord. Methadone works in this way, too. But it also blocks the N-methyl-D-aspartate (NMDA) receptor, which may play a role in some types of nerve pain.
NMDA blocking is one way methadone differs from buprenorphine, another opioid medication that doctors sometimes prescribe for pain or OUD treatment. The two drugs act differently in the body and have different safety concerns.
Methadone for pain relief and methadone for OUD treatment involve the same medication, but their goals, dosing, and monitoring differ. Pain treatment relieves discomfort, while OUD treatment reduces cravings and withdrawal symptoms. In general, only doctors who are familiar with the unique dosing and monitoring requirements of methadone should prescribe the medication.
Methadone is not typically considered a first choice opioid in treating chronic pain. This is because it can have serious side effects like delayed respiratory depression (slowed or shallow breathing) and electrical problems in the heart.
If your doctor does prescribe methadone for pain, they set the dose based on your pain level, other medications, and overall health. You can fill a methadone prescription for pain at a regular pharmacy, just like other prescriptions.
Doctors prescribe methadone for OUD as part of a comprehensive MOUD plan, typically dispensed through a certified opioid treatment program (sometimes called a methadone clinic). These programs offer counseling and other support as well.
Taking methadone for pain doesn’t mean you have OUD, and having OUD doesn’t mean you can’t also take pain management for a separate condition. These are related but distinct situations, and your care team can help sort out which applies to you.
A doctor might suggest methadone for pain when other opioids or other pain medications haven’t worked well or have caused difficult side effects. Methadone often helps treat people with cancer, terminal illnesses, and long-term pain conditions.
Methadone can help with cancer-related pain, including pain caused by tumors pressing on nerves or by cancer treatment itself. Its combined action on pain receptors can make it useful for these mixed pain types.
Methadone may also be a good choice for people with kidney problems, since the drug is cleared mainly through the digestive system rather than relying on the kidneys.
Your healthcare provider may prescribe methadone if its possible benefits are greater than its possible risks.
Like all opioids, methadone carries risks that your care team will help you manage.
Because methadone builds up in the body more slowly and unevenly than many opioids, finding the right dose takes time. Doses usually start low and increase gradually. Raising the dose too quickly can cause side effects to build up before they become noticeable.
A methadone overdose can be life-threatening, particularly during the first few days of treatment or shortly after a dose increase. Warning signs of overdose include:
It’s worth asking your doctor about keeping naloxone (sold under brand names like Kloxxado, Narcan, Rezenopy, and Zimhi) on hand to reverse an opioid overdose in an emergency.
Methadone interacts with a wide range of other substances. For example, combining it with alcohol, benzodiazepines, or other sedating medications raises the risk of dangerous respiratory depression.
Other medications can also raise or lower methadone levels in the body. Be sure to share a full list of everything you take with your doctor and pharmacist.
Methadone can affect the heart’s electrical rhythm. Doctors track this rhythm using a measurement called the QTc interval, which they measure through a heart test called an electrocardiogram (ECG).
The risk of electrical problems seems to be higher at larger doses than at lower doses of methadone. But doctors still monitor the QTc interval closely in anyone starting methadone.
Methadone for pain is started cautiously and adjusted slowly, with close attention paid to both pain relief and safety.
People who haven’t taken opioids before typically start at a low dose. Small increases may be spaced roughly five to seven days apart.
People who already take other opioids usually switch to methadone through a careful conversion process. This process is important because methadone can be stronger than expected, even at a small dose.
Before prescribing methadone, doctors typically check for heart rhythm risk factors and order a baseline ECG. A follow-up ECG within two to four weeks helps confirm the heart rhythm is staying stable.
Pain relief, side effects, and check-ins with your doctor will guide dose changes. That’s why methadone treatment often takes several weeks to settle into a steady routine.
Common side effects of methadone include:
Most of these ease over time or can be managed. For example, doctors often recommend a fiber-rich diet or a stool softener for constipation.
Tell your doctor about any side effect that feels severe or sudden or doesn’t improve over time.
Safe methadone use depends on following your prescription closely, storing the medication securely, and staying in touch with your care team.
Take methadone exactly as prescribed, at the same times each day. Never take an extra dose to make up for a missed one or to relieve pain faster.
Never drink alcohol while taking methadone. Do not use benzodiazepines while taking methadone unless your doctor has explicitly prescribed them together and is closely monitoring your treatment. Combining them raises the risk of dangerous sedation and slowed breathing.
Store methadone out of sight and reach of children, other household members, and pets. Even a small amount can be dangerous to someone it wasn’t prescribed for. Keep the medication in its original container, and follow your pharmacist’s disposal instructions once treatment ends.
Ongoing check-ins and, occasionally, repeat ECGs are part of how you can stay safe over time.
If you want to stop taking methadone, talk to your doctor first. Stopping suddenly can bring on withdrawal symptoms like muscle aches, sweating, and trouble sleeping. Your doctor can help you taper the medication gradually instead.
Before your next appointment, write down every medication you’re taking, note any side effects you’ve had, and ask your doctor whether an ECG is part of your monitoring plan. If your doctor is considering methadone to treat your pain, ask whether it fits your situation and health history.
On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.
Has your doctor talked to you about methadone for pain, and how did that conversation go? Let others know in the comments below.
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I’m on methadone and i have seen several people with back problems after drinking this I don’t drink much this Methadone. I’m on 35 mg and it’s starting to make my back hurt. So how does it help with… read more
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