Opioid dose escalation may cause hyperalgesia, mediated by the N-methyl-D-aspartate (NMDA) pathway. Methadone is an atypical opioid that inhibits hyperalgesia through NMDA blockade, especially at low doses.
Objective: To evaluate the efficacy of using very-low-dose methadone as the sole long-acting opioid agent in a hospice practice.