Opioid Rotation to Methadone for Refractory Cancer Pain: A Case Series

Khoo, Shiao-Yen; Aziz, Fauziah Abd; Nambbiar, Prita

doi:10.1080/15360288.2019.1666956

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Approximately 10-20% of patients experience refractory cancer pain that is poorly responsive to commonly used opioids such as morphine, oxycodone, and fentanyl, or who have dose-limiting intolerable adverse effects [5,6,9]. Methadone is considered an attractive alternative in these situations [8,9,11]. This study evaluated the effect of methadone on refractory cancer pain in patients in China.…”

Section: Discussionmentioning

confidence: 99%

“…However, 10-20% of patients who are prescribed opioids still experience inadequate pain relief and/or intolerable adverse reactions, which can be defined as refractory pain [5][6][7]. Methadone is commonly considered an alternative opioid treatment for refractory cancer pain [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, adverse methadone-related cardiac events are of concern, especially cardiotoxicity of prolonged corrected QT interval (QTc) and torsade de pointes (TdP) [18,19]. Clinical data on methadone for cancer pain management are still limited, especially for Asian patients [8,9,17,20]. Therefore, the present study aimed to evaluate the efficacy, tolerance, and economy of opioid switching to methadone in the management of refractory cancer pain.…”

Section: Introductionmentioning

confidence: 99%

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Methadone switching for refractory cancer pain

et al. 2022

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Background Methadone is commonly considered an alternative opioid treatment for refractory cancer pain. This study aims to investigate the efficacy, safety, and cost of methadone in the treatment of refractory cancer pain. Methods A retrospective study was conducted in patients who used methadone for refractory cancer pain from April 2016 to December 2020 at a cancer specialized hospital. Pain control, evaluated via pain score and breakthrough pain frequency, and adverse events of methadone were compared with analgesic regimens prior to methadone administration. The factors potentially affecting the switching outcome were analyzed via multivariate analysis. Moreover, the cost of pain control was estimated. Results Ninety patients received methadone for poor pain control (74.4%), intolerable adverse events (10.0%), or both (15.6%) after prior opioid treatments. Sixty-four patients (71.1%) were successfully switched to methadone with median pain score significantly decreased from 4.0 to 2.0 (p < 0.001) and median daily frequency of breakthrough pain from 3.0 to 0.0 (p < 0.001) at a maintained median conversion ratio of 6.3 [interquartile range (IQR): 4.0–10.0] to prior opioid treatment. Similar adverse event profiles of constipation, nausea, vomiting, and dizziness were observed between methadone and prior opioid regimens. The median daily cost of analgesic regimens was significantly reduced from $19.5 (IQR: 12.3–46.2) to $10.8 (IQR: 7.1–18.7) (p < 0.01) after switching to methadone. The 3-day switch method significantly improved the rate of successful switching compared with the stop and go method (odds ratio = 3.37, 95% CI: 1.30–8.76, p = 0.013). Conclusion Methadone is an effective, safe, and cost-saving treatment for patients with refractory cancer pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Methadone switching for refractory cancer pain

et al. 2022

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“…[ 23 36 50 ] Opioid conversion to methadone should be done under clinical supervision with individualized dose titration to prevent serious adverse effects. [ 47 48 49 51 ]…”

Section: Discussionmentioning

confidence: 99%

Methadone in Cancer Pain

Ramkiran

Thota

2020

Indian J Palliat Care

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Methadone has been an unique, versatile, cost effective, synthetic opioid utilized in nociceptive as well as neuropathic pain. Pain and palliative care physicians started accepting methadone in treatment of complex pain associated with advanced cancer and neuropathic pain syndromes in which conventional opioids were no longer effective. The challenge is in accepting methadone as a main stream first line opioid, from being considered as a second line replacement/substitution drug all these years. Methadone has a significant role as opioid rotation in refractory cancer pain, especially when started early leading to successful conversion. Advantages of methadone in paediatric patients with advanced cancer were its safety and efficacy as a first-choice opioid, availability as a liquid formulation and its infrequent dose requirements. Methadone is neither recommended nor justified to be used as an anti-cancer drug and its role as an anti-cancer agent is a misconception. Many guidelines were proposed after 2008 to address methadone safety. Most of them emphasized on prevention of cardiac arrhythmia and association of methadone with QTc prolongation rather than address the real issue. Methadone has been established to be safe when used in opioid naïve patients with careful titration instituted in an ambulatory setting and has equal success in opioid rotation in outpatient setup. Methadone prescription should be carried out by experienced pain and palliative care providers with careful dose titration and clinical monitoring.

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