Advanced Pain Therapies: Using Methadone, Ketamine, and Lidocaine for Refractory Pain (P14) (Advanced)

Abstract

1.Describe methadone's unique pharmacokinetic and pharmacodynamic properties and drug-interaction profile.2.Discuss how to convert and manage appropriate patients on both oral and intravenous methadone, using a variety of accepted strategies.3.Describe protocols for the use of lidocaine and ketamine in pain management. Refractory pain management is one of the greatest clinical challenges for clinicians in hospice and palliative care settings. Helping patients who have moved beyond the World Health Organization analgesic ladder requires familiarity with methadone and less commonly used adjuvants such as lidocaine and ketamine. An understanding of methadone's unique pharmacokinetic and pharmacodynamic properties and drug interaction profile is paramount to safely prescribing methadone. Methadone prescribers must also have knowledge of various dosing ratios and methods for converting between methadone and other opioids in order to customize methadone therapy for their patients. Furthermore, prescribers of intravenous methadone must be familiar with recently published consensus guidelines for optimizing analgesia with parenteral methadone. Following didactic presentations, attendees working in small groups will apply the basic principles of methadone prescribing to patient cases that enable them to develop comfort with using methadone for pain management. Finally, the use of lidocaine and ketamine for the treatment of refractory pain will be discussed, with a focus on determining the best route of administration and dosages. Suggestions for developing protocols for their use will be offered. Physical Aspects of Care