Long-term therapy of chronic non-malignant pain with potent opioids in an active police officer

Abstract

PURPOSE: To report the successful long-term use of methadone and tramadol in treating low back pain in a marine police officer. Principal findings: The patient sustained a work-related injury having fallen down stairs while on duty in 1990. After multiple operations for a prolapsed L5/S1 intervertebral disk, he was first seen at our pain clinic in 1994. Numerous systemic medications, invasive procedures, physiotherapy and psychotherapy were used to treat his pain, but without sustained effect. Methadone was started in late 1995 and tramadol in 2000. The current maintenance doses are methadone 20 mg and tramadol 200 mg, both twice daily. Apart from some initial disruption, the patient was soon able to return to full time work. Regular performance reports from his supervisors have always been excellent. CONCLUSION: The use of methadone in this police officer with chronic low back pain has been very successful despite the demanding nature of his job. The controversy surrounding, and further suggestions regarding long-term use of opioid therapy for non-malignant pain are discussed.