Relationship between serum methadone concentration and cold pressor pain sensitivity in patients undergoing methadone maintenance therapy

Authors

  • Chee Siong Lee Department of Emergency Medicine, School of Medical Sciences, USM, Kelantan, Malaysia
  • Nasir Mohamad Faculty of Medicine & Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
  • Nurfadhlina Musa Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
  • Rusli Ismail Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
  • Soo Choon Tan Pharmacogenetics and Novel Therapeutics Cluster, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia (USM), Kelantan, Malaysia
  • Yeong Yeh Lee School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
  • ZALINA ZAHARI Department of Pharmacy, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Abstract:

Hyperalgesia is a common clinical phenomenon among opioid dependent patients on methadone maintenance therapy (MMT) and it may be associated with undertreated pain and/or therapeutic failure. This study aimed to investigate association between serum methadone concentration (SMC) and cold pressor pain responses. Cold pressor pain responses in 147 opioid dependent patients on MMT were assessed using cold pressor test (CPT) at 0 hour and at 2, 4, 8, 12, and 24 hours after the dose intake. Blood samples were collected at 24 hours after the dose. Serum methadone concentrations were measured using the Methadone ELISA kit and classified into two categories: < 400 ng/ml and ≥ 400 ng/ml. Eighty-eight patients (59.9%) had trough concentrations of < 400 ng/ml and 40.1% had trough concentrations of ≥ 400 ng/ml. There were significant effects of SMC on the cold pressor pain threshold (p = 0.019). Patients with concentrations < 400 ng/ml had significantly higher (almost 60% higher) cold pressor pain threshold (adjusted mean (95% CI) = 30.15 (24.29, 36.01) seconds) compared to those with concentrations of ≥ 400 ng/ml (18.93 (11.77, 26.08) seconds). There was also a 20% difference in pain tolerance, and 6% difference in cold pressor pain intensity score, neither of which were significant statistically (p > 0.05). Our results suggest an association of trough methadone concentration with the cold pressor pain threshold among opioid dependent patients on MMT. It would be useful to study the mechanisms underlying this association to help managing pain in such a population.

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Journal title

volume 17  issue Special Issue

pages  8- 16

publication date 2018-03-01

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