O uso de opióides no tratamento da dor crônica não oncológica: o papel da metadona

Sady Ribeiro; André Prato Schmidt; Sérgio Renato Guimarães Schmidt

doi:10.1590/S0034-70942002000500015

Review Article

O uso de opióides no tratamento da dor crônica não oncológica: o papel da metadona

Opioids for treating non malignant chronic pain: the role of methadone

Sady Ribeiro; André Prato Schmidt; Sérgio Renato Guimarães Schmidt

http://dx.doi.org/10.1590/S0034-70942002000500015 Braz J Anesthesiol, vol.52, n5, p.644-651, 2002

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Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de opióides em dor oncológica já é bastante difundido e comprovado por diversos ensaios clínicos bem controlados. Entretanto, há uma grande controvérsia em relação ao uso em longo prazo de opióides em dor crônica de origem não oncológica, que tem se intensificado de forma importante nos últimos anos. Neste estudo, objetivamos avaliar criticamente as informações disponíveis na literatura a respeito do uso de opióides para tratamento de dor crônica não oncológica e o papel da metadona como opção terapêutica. CONTEÚDO: Os estudos disponíveis ainda são limitados, mas demonstram que determinadas subpopulações de pacientes portadores de dor crônica podem alcançar analgesia importante, com pouca tolerância e baixo potencial para adição, principalmente aqueles refratários aos esquemas terapêuticos convencionais. Morfina é o opióide padrão, mas outras alternativas podem ser utilizadas como oxicodona, hidromorfona ou fentanil. Metadona é um opióide sintético, inicialmente utilizado para prevenir síndrome de abstinência em paciente dependentes, que também constitui uma importante opção no tratamento da dor crônica não oncológica, principalmente dor neuropática. CONCLUSÕES: Apesar do conhecimento crescente sobre o uso de opióides em dor crônica não oncológica, novos estudos melhor controlados ainda são necessários para uma discussão mais científica a respeito do assunto. A metadona administrada por via oral apresenta uma boa relação custo-benefício, representando uma alternativa efetiva para um melhor controle da dor em alguns pacientes.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, DOR

Abstract

BACKGROUND AND OBJECTIVES: The use of opioids for cancer pain has already well established by several well-controlled clinical trials. However, there is a major controversy about long-term use of opioids in non-malignant chronic pain, which has been significantly intensified in the last few years. This study aimed at evaluating available data on the use of opioids for treating non-malignant chronic pain and the role of methadone as a therapeutic alternative. CONTENTS: There are few available studies, but they show that some subpopulations of chronic pain patients may achieve sustained analgesia with minor tolerance and low addiction potential, mainly those refractory to conventional therapy. Morphine is the standard opioid, but other alternatives may be used such as oxycodone, hydromorphone or fentanyl. Methadone is a synthetic opioid, initially used to prevent withdrawal syndrome in addicted patients, which may be an important alternative for treating non-malignant chronic pain, especially neuropathic pain. CONCLUSIONS: Although the growing knowledge on the use of opioids for treating non-malignant chronic pain, new better controlled studies are still needed to allow a more scientific discussion about this subject. Oral methadone is cost-effective and an effective alternative for a better pain control in certain patients.

Keywords

ANALGESICS, ANALGESICS, PAIN

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O uso de opióides no tratamento da dor crônica não oncológica: o papel da metadona

Opioids for treating non malignant chronic pain: the role of methadone

Sady Ribeiro; André Prato Schmidt; Sérgio Renato Guimarães Schmidt

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