Methadone use in children and young adults at a cancer center: A retrospective study

Abstract

Objective To augment the literature on methadone applications in pediatric oncology, the authors reviewed the use of methadone at a pediatric cancer center over a 5-year period. Design and setting Forty-one patients received methadone for inpatient or outpatient pain management. The authors retrospectively reviewed their demographic characteristics, diagnoses, type of pain (nociceptive, neuropathic, or mixed) and causes of pain, and the indications, dose regimens, adverse effects, and outcomes of methadone treatment. Results There were four types of clinical uses for methadone in 41 patients (10 patients had two): nociceptive pain unresponsive to other opioids (17 patients, 33.3 percent), neuropathic pain (20 patients, 39.2 percent), facilitation of weaning from opioids (11 patients, 21.6 percent), and end-of-life pain management (3 patients, 5.9 percent). The mean age of the 24 males (58.5 percent) and 17 females (41.5 percent) at the start of treatment was 15.7 years (range, 0.6–23 years). The most common diagnoses were leukemia (n = 10, 24.4 percent), osteosarcoma (n = 7, 17.0 percent), and rhabdomyosarcoma (n = 5, 12.2 percent). The causes of pain were bone marrow transplant (n = 13, 31.7 percent), amputation (n = 6, 14.6 percent), chemotherapy (n = 5, 12.2 percent), tumor (n = 5, 12.2 percent), limb-sparing surgery (n = 4, 9.8 percent), and other (n = 8, 19.5 percent). Efficacy was assessed at the end (or after 6 months) of methadone treatment. For many patients (43.1 percent), methadone showed efficacy in achieving the purpose for which it was prescribed, including reduction of nociceptive or neuropathic pain and prevention of opioid withdrawal. Sedation was the most common side effect (24.4 percent). Conclusions Methadone was effective for pediatric patients with neuropathic pain or nociceptive pain unresponsive to other opioids, and it effectively prevented opioid withdrawal.

Morte digna da criança: percepção de enfermeiros de uma unidade de oncologia

“…Pain takes on a special meaning when it happens to children, who are seen as innocent and free from sin and therefore should not suff er. It is extremely important to recognize pain or physical discomfort and make appropriate use of medica ons for eff ec ve pain control (12)(13) , as well as to implement non-pharmacological measures for pain relief, such as massage, the use of compresses, music therapy and relaxa on (12) .…”

Tratamiento opioide del dolor mixto en pacientes pediátricos asistidos por el equipo de Cuidados Paliativos. Cinco años de experiencia

“…Existen dolores de difícil manejo que requerirán distintas asociaciones de fármacos para buscar obtener el máximo alivio del dolor con el mínimo de efectos adversos. 3,8,9 Por tratarse de dolor mixto de intensidad moderada a grave en niños con enfermedades amenazantes para la vida, la utilización de opioides estuvo presente en todos los casos, y el más frecuente fue morfina.…”

“…En la literatura, se describen sus usos para el tratamiento del dolor nociceptivo y neuropático. 7,9,10 Es un opioide de uso seguro en niños cuando la morfina no controla el dolor mixto.…”

Opioid treatment for mixed pain in pediatric patients assisted by the Palliative Care team. Five years of experience

“…Methadone use has been described in the bibliography for the treatment of nociceptive and neuropathic pain. 7,9,10 It is a safe opioid for use in children when mixed pain is not controlled by morphine.…”

“…Some types of pain are difficult to manage and will require different drug combinations to attain the highest level of pain relief with minimum adverse effects. 3,8,9 Given that this study focused on moderate to severe mixed pain in children with lifethreatening diseases, opioids were used in all cases; the most common opioid was morphine.…”