Edema in a patient receiving methadone for chronic low back pain.

PURPOSE: The case of a patient who developed edema after receiving methadone for chronic low back pain is reported.

SUMMARY: A 45-year-old white woman developed edema in her lower extremities one week after starting methadone, etodolac, and gabapentin as part of her treatment for chronic low back pain. She was taking methadone as part of her treatment regimen to manage her pain in addition to other agents, including etodolac and gabapentin. After several days on this therapy, she developed edema and stated that she was "feeling drunk." At that time the etodolac and gabapentin were stopped, and the methadone dosage was increased. Several days later, the patient returned to the pain clinic, complaining of continued swelling. The methadone dosage was then decreased, and a diuretic was added to treat the edema; however, her edema did not resolve with the lower dosage of methadone. Methadone was then discontinued, and a fentanyl patch was prescribed. Prednisone was also prescribed, and the dosage of the diuretic was increased. The patient's symptoms resolved, and prednisone was ultimately tapered. The likelihood that the administration of methadone was related to the development of edema in this patient was determined to be probable. There have been a few cases reported in the literature regarding the development of edema with methadone use. In the cases reported, the edema developed after three to six months of methadone therapy.

CONCLUSION: A patient with chronic low back pain developed edema one week after receiving methadone as part of her pain management regimen.