The use of methadone in cancer pain poorly responsive to other opioids

Morley, J. S.; Makin, Matthew

doi:10.1191/096813098673619329

Cited by 120 publications

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“…With a stop-start approach, it allows for quick tissue methadone distribution, achieving steady plasma level and satisfactory analgesia within 1-2 days, which is crucial for patients with severe pain, and also fast elimination of morphine metabolites [28]. The Morley and Mankin "ad libitum" approach does not guarantee that a steady plasma level is achieved quick because for the first 5 days methadone is administered on a patient's demand [34]; moreover, methadone may be administered every 3 h, which is not in agreement with its long half-life and may lead to toxicity [27]; thus, this approach was not used in this study.…”

Section: Methodsmentioning

confidence: 99%

The role of methadone in opioid rotation—a Polish experience

Leppert

2008

Support Care Cancer

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Section: Methodsmentioning

confidence: 99%

The role of methadone in opioid rotation—a Polish experience

Leppert

2008

Support Care Cancer

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“…These characteristics allow the safe use of Meth for the attenuation of detoxification-associated signs of abstinence syndrome and long-term substitution therapy in opiate drug (mostly heroin) addicts. Meth is also an effective analgesic in a considerable subset of Morph-resistant patients [28]. In contrast to Morph, it is not converted to active metabolites in vivo, but is cleared at a considerably slower rate so it can accumulate in tissues after repeated administration.…”

Section: Introductionmentioning

confidence: 99%

Stress-opioid interactions: a comparison of morphine and methadone

Taracha

Mierzejewski

Lehner

et al. 2009

Pharmacological Reports

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Abstract:The utility of methadone and morphine for analgesia and of methadone for substitution therapy for heroin addiction is a consequence of these drugs acting as opioid receptor agonists. We compared the cataleptogenic and antinociceptive effects of single subcutaneous doses of methadone hydrochloride (1-4 mg/kg) and morphine sulfate (2.5-10 mg/kg) using catalepsy and hot-plate tests, and examined the effects of the highest doses of the drugs on Fos protein expression in selected brain regions in male Sprague-Dawley rats. Methadone had greater cataleptogenic and analgesic potency than morphine. Fos immunohistochemistry revealed substantial effects on the Fos response of both the stress induced by the experimental procedures and of the drug exposure itself. There were three response patterns identified: 1) drug exposure, but not stress, significantly elevated Fos-positive cell counts in the caudate-putamen; 2) stress alone and stress combined with drug exposure similarly elevated Fos-positive cell counts in the nucleus accumbens and cingulate cortex; and 3) methadone and morphine (to a lesser extent) counteracted the stimulatory effect of nonpharmacological stressors on Fos protein expression in the somatosensory cortex barrel field, and Fos-positive cell counts in this region correlated negatively with both the duration of catalepsy and the latency time in the hot-plate test. The overlap between brain regions reacting to nonpharmacological stressors and those responding to exogenous opioids suggests that stress contributes to opioid-induced neuronal activation.

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“…Opiates and other pain medications are a symptomatic approach to aiding pain and do not provide a definitive cure. Additionally, the use of potent opiates such asmethadone or hydromorphone carry a high risk of developing addiction, tolerance and abuse among patients [9,10]. Furthermore, the side effects of opiates may cause many side effects including headaches themselves and may contribute further to pain by hypersensitivity or drug to drug interactions.…”

Section: Discussionmentioning

confidence: 99%

The Use of Methadone in Refractory Headache Pain in an Opiate Naive Patient with Non Metastatic Burkitt’s Lymphoma and HIV - A Case Report

Stotland¹,

Rahimzad²

2016

J Pain Relief

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In extreme cases Methadone has been used for severe pain in oncologic patients; frequently cancer patients have severe headaches in addition to their pain. This patient is a 50 year old Hispanic female with metastatic Burkitt's Lymphoma and controlled HIV on triple therapy. Throughout her inpatient hospitalizations of chemotherapy with R-EPOCH and then salvage chemotherapy in addition to pancytopenia she experienced consistent pain of 9-10 out of 10 on the pain scale and headaches of 9-10 in severity out of 10. The patient underwent various methods of pain and headache control including PCA of hydromorphone, intravenous and oral hydromorphone, intravenous morphine, intravenous Tylenol, Fioricet and oral analgesics. The patient received moderate relief with oral Methadone of both her pain and headaches, bringing the pain and headache scale down to a 4-5 out of 10. This is the first case of intractable pain and headaches in an opiate naive patient with non-metastatic Burkitt's Lymphoma and HIV that received with 50 percent reduction in symptoms from the addition of oral Methadone that has no prior use of opiate abuse or dependence.

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The use of methadone in cancer pain poorly responsive to other opioids

Cited by 120 publications

References 0 publications

The role of methadone in opioid rotation—a Polish experience

The role of methadone in opioid rotation—a Polish experience

Stress-opioid interactions: a comparison of morphine and methadone

The Use of Methadone in Refractory Headache Pain in an Opiate Naive Patient with Non Metastatic Burkitt’s Lymphoma and HIV - A Case Report

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