Methadone
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Zhou K, et al. Tapering off long-term methadone: A case study. Journal of Opioid Management 15: 345-348, No. 4, Jul-Aug 2019. Available from: URL: http:// doi.org/10.5055/jom.2019.0520 - USA 803435768
Opioid use disorder: case report An adult woman [exact age at reaction onset not stated] developed opioid use disorder during treatment with methadone for lumbosacral radiculopathy. An obese woman, who had arthritis, diabetes, sleep apnoea and anxiety, presented at the age of 62 years with lower back pain for more than 10 years. She had undergone two total knee replacement surgeries. Prior to current presentation, she had received various medications including oxycodone and fentanyl patch for her pain. More than 6 years prior to current presentation, she had started receiving methadone [route and initial dosage not stated]. Later, due to unsatisfactory pain control, the dosage of methadone was increased to 120 mg/day. However, the intractable pain continued and additionally she developed intolerable drowsiness. Therefore, the dosage of methadone was decreased to 90 mg/day. Eventually, the woman presented to another hospital (current presentation) on 13 June 2014. By that time, she was wheelchair bound due continuous pain. She had also developed day time sleepiness, depression, constipation, insomnia, chest tightness and palpitations, and shortness of breath. She was receiving modafinil for decreased mentation. Based on findings of physical examination, she was diagnosed with lumbosacral radiculopathy and opioid use disorder [duration of treatment to reaction onset not stated]. She was treated with S1 epidural injection, which relieved her back pain remarkably. For the treatment opioid use disorder, methadone tapering by 10 mg/day each week was planned. Along with manual stretch she was prescribed with clonidine and escitalopram. She was trained for home exercises, self stretch and heating/ice pad use. She returned on 26 June 2014 while receiving methadone 55 mg/day. She exhibited no signs or symptoms of withdrawal. Over the the previous few days, she had increased pain over the left sole. She was treated with repeated epidural injection, which resolved her S1 radiculopathy symptoms. The methadone dosage was further decreased to 50 mg/day and a taper of 5 mg/day in each week along with slow taper of modafinil was planned. Lamotrigine therapy was also started. On 31 July 2014 while receiving methadone 35 mg/day, she was treated with trigger point injection for tenderness over bilateral lower leg and the left middle back. Lamotrigine dose was increased and modafinil was stopped. On 15 September 2014 while receiving methadone 15 mg/day, dose of clonidine was increased, and a decrease in the dose of methadone to 2.5mg twice a day for 2 weeks and then 2.5 mg/day for 2 weeks was planned. On 4 November 2014, she presented due to pain exacerbation even though she had increased the dose of methadone to 2.5mg three times a day. Repeated epidural injection was performed and the dose of escitalopram was increased. Methadone
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