Dextromoramide abuse was identified in a patient on methadone therapy. He d
eveloped bacteremia, during which complicated nephrolithiasis was diagnosed
. This required surgery, after which specific pain therapy was given. Pain
management in patients on methadone therapy is discussed. Although pain can
be masked by the use of narcotics, methadone therapy does not provide adeq
uate pain relief and requires specific therapeutic adjustments.