Opioid rotation: A case example using methadone in spinal cord injury.

Opioid rotation is a practice used when patients with chronic pain have insufficient analgesia, experience unwanted opioid-related adverse reactions, or other pharmacologic challenges with their current opioid. Methadone is an opioid with unique pharmacological properties, which render it clinically distinct from other opioids. The drug's potential clinical benefits in treating nociceptive and neuropathic pain are coupled with risks of serious, life-threatening adverse reactions. Its unique pharmacokinetic profile contributes added complexity; therefore, clinicians should be experienced with its dosing and monitoring. This report discusses the successful use of methadone during opioid rotation for chronic pain secondary to spinal cord injury.