Addition of Methadone to Another Opioid in the Management of Moderate to Severe Cancer Pain: A Case Series.

J Palliat Med. 2013 Feb 7;
Wallace E, Ridley J, Bryson J, Mak E, Zimmermann C

Abstract Background: Previous research has reported improved pain after adding methadone to another opioid, but did not quantify this benefit using a validated outcome measure. Objective: To assess quantitatively the effectiveness of adding methadone to another opioid for moderate to severe cancer-related pain. Design: All outpatients attending the Oncology Palliative Care Clinic from September 2010-September 2011, who had received methadone, were identified from pharmacy records. Inclusion criteria included: histological diagnosis of malignancy, age >18 years, taking regular opioids and Edmonton Symptom Assessment System (ESAS) pain score ?4. Measurement: The primary outcome measure was a decrease in pain score of ?2 points from methadone initiation to one-month follow-up (or closest available ESAS). Results: Twenty patients were available for analysis, 16 of whom had neuropathic pain (80%). Eight patients (40%) had a decrease in pain score of ?2 points at 1 month and a further 7 (35%) had a decrease of ?2 points at the closest available time point. The mean pain score decreased from 7.7?+/-?1.8 to 5.2?+/-?2.4 from time of initiation to time of evaluation. The mean daily routine morphine equivalent, (excluding methadone), was 338?+/-?217.8?mg/day at initiation and 332?+/-?191?mg/day at evaluation; for methadone, mean doses at initiation and evaluation were 4.4?+/-?1.4?mg/day and 15.5?+/-?5.9?mg/day, respectively. Methadone was well tolerated in 17 patients (85%). Conclusions: The addition of methadone was associated with improved pain control for patients with moderate to severe pain on another opioid and appears to offer a safe, well-tolerated and practical alternative in this situation.
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