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To the Editor: Dr Rosenblum and colleagues¹ found that a high percentage of patients in methadone maintenance therapy programs (MMTPs) reported chronic pain.The authors pointed out that patients in MMTPs have been found to be more sensitive to pain in laboratory conditions. Their data extend this experimental finding into clinical practice, by demonstrating that patients in MMTPs complain of significantly higher levels of pain than do those in general population.

Nearly half of the MMTP patients in the study by Rosenblum et al received prescribed opioids for pain. This suggests that rather than being protected from pain by their substantial opioid dose, methadone-maintained patients become more pain sensitive. Indeed, Rosenblum et al found that chronic severe pain correlated with duration of methadone maintenance. This is consistent both with concerns that overtreatment of pain in MMTP patients may be more common than undertreatment,^2-3 as well as with animal studies that have . . . [Full Text of this Article]

Jon Streltzer, MD
Department of Psychiatry
John A. Burns School of Medicine
University of Hawaii
Honolulu

Thomas R. Kosten, MD
Departments of Psychiatry and Medicine
Yale University School of Medicine
New Haven, Conn

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