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In Reply: We agree with Drs Streltzer and Kosten that physicians should not prescribe opioids to patients in MMTPs (or indeed to any patient) merely because of the possibility that their pain might be undertreated. Opioid therapy should be considered only after a careful assessment to determine the nature and impact of pain, and only after considering the risks and benefits for the specific patient compared with other potentially analgesic treatments.¹

We disagree, however, with their speculation that the high prevalence of pain in MMTP patients is due to opioid-induced increased sensitivity to pain. Neither the animal studies of the complex neurophysiology of opioid systems, nor the finding of increased sensitivity to experimental pain among patients in MMTPs, has any proven relationship to clinical pain. An alternative hypothesis is that the MMTP population has a high prevalence of painful medical disorders.² Patients with chronic pain also may be disinclined to . . . [Full Text of this Article]

Russell K. Portenoy, MD; Andrew Rosenblum, PhD; Herman Joseph, PhD; Steven Kipnis, MD

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Methadone Maintenance Therapy and Chronic Pain
Jon Streltzer and Thomas R. Kosten
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