Language
English
Publication Date
4-8-2025
Journal
Psychopharmacology Bulletin
DOI
10.64719/pb.4536
PMID
40223915
PMCID
PMC11983473
PubMedCentral® Posted Date
4-8-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Methadone is frequently used for chronic pain management due to its long half-life and NMDA receptor activity, making it an effective option for opioid-tolerant patients. Buprenorphine-naloxone is increasingly explored as an alternative for chronic pain and opioid use disorder, offering partial opioid agonism with a ceiling effect on respiratory depression. The transition from methadone to buprenorphine-naloxone remains clinically challenging, requiring careful management to prevent withdrawal and ensure adequate pain control.
Case descriptions: Two patients with chronic pain were transitioned from methadone to buprenorphine-naloxone. The first patient, a mid-40s female, was abruptly switched from methadone 10 mg twice daily dosing to buprenorphine-naloxone 4 mg-1 mg twice daily dosing without a taper, resulting in severe withdrawal requiring hospitalization. The second patient, a late-50s male, underwent a two-month methadone taper before initiating buprenorphine-naloxone 4 mg-1 mg twice daily dosing, but reported persistent uncontrolled pain despite dose escalation to 4 mg-1 mg three times a day. Both patients reported significant dissatisfaction with buprenorphine-naloxone therapy, citing inadequate pain relief. Both patients eventually left the practice and were lost to follow up.
Conclusion: These cases underscore the challenges of transitioning chronic pain patients from methadone to buprenorphine-naloxone formulations. Transitioning patients between these medications may lead to issues regarding withdrawal symptoms, inadequate pain control, and patient attrition.
Keywords
Humans, Chronic Pain, Methadone, Buprenorphine, Naloxone Drug Combination, Female, Male, Middle Aged, Analgesics, Opioid, Adult, Opiate Substitution Treatment, Substance Withdrawal Syndrome, Opioid-Related Disorders, methadone, buprenorphine, chronic pain, pain management, neuropathic pain, opioid use disorder, opioid rotation
Published Open-Access
yes
Recommended Citation
Hasoon, Jamal; Nguyen, Anvinh; Viswanath, Omar; et al., "Challenges in Transitioning from Methadone to Buprenorphine-Naloxone for Chronic Pain Management: Two Cases" (2025). Faculty, Staff and Students Publications. 6527.
https://digitalcommons.library.tmc.edu/baylor_docs/6527