Pain responses in methadone-maintained opioid abusers

J Pain Symptom Manage. 2000 Oct;20(4):237-45. doi: 10.1016/s0885-3924(00)00191-3.


Providing pain management for known opioid abusers is a challenging clinical task, in part because little is known about their pain experience and analgesic requirements. This study was designed to describe pain tolerance and analgesic response in a sample of opioid addicts stabilized in methadone-maintenance (MM) treatment (n = 60) in comparison to matched nondependent control subjects (n = 60). By using a placebo-controlled, two-way factorial design, tolerance to cold-pressor (CP) pain was examined, both before and after oral administration of therapeutic doses of common opioid (hydromorphone 2 mg) and nonsteroidal anti-inflammatory (ketorolac 10 mg) analgesic agents. Results showed that MM individuals were significantly less tolerant of CP pain than control subjects, replicating previous work. Analgesic effects were significant neither for medication nor group. These data indicate that MM opioid abusers represent a pain-intolerant subset of clinical patients. Their complaints of pain should be evaluated seriously and managed aggressively.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cold Temperature / adverse effects
  • Drug Interactions / physiology*
  • Female
  • Humans
  • Hydromorphone / administration & dosage
  • Hydromorphone / adverse effects
  • Ketorolac / administration & dosage
  • Ketorolac / adverse effects
  • Male
  • Methadone / adverse effects*
  • Middle Aged
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / physiopathology*
  • Pain / drug therapy*
  • Pain / physiopathology
  • Pain Measurement / statistics & numerical data
  • Pain Threshold / drug effects
  • Pain Threshold / physiology
  • Pressure / adverse effects
  • Reaction Time / drug effects
  • Reaction Time / physiology


  • Hydromorphone
  • Methadone
  • Ketorolac