Use of Methadone as a Coanalgesic

McKenna, Maria K.; Nicholson, Alexander B

doi:10.1016/j.jpainsymman.2011.06.005

Cited by 17 publications

(17 citation statements)

References 5 publications

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“…There is emerging evidence that low-dose methadone as an add-on twice daily to already existing high-dose opioid treatment increases the pain-relieving effect in complex pain [14][15][16][17][18]. This is also the general opinion in the current study.…”

Section: Recommendations For Future Researchsupporting

confidence: 52%

“…This is of particular interest in complex pain syndromes. In such cases, combining an ongoing high-dose opioid treatment with a low fixed dose of methadone has become increasingly popular in specialized palliative care, not least in Sweden [14][15][16][17][18]. Still, the appropriate indications for, as well as practical uses of, low-dose methadone have been insufficiently defined.…”

Section: Methadonementioning

confidence: 99%

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Methadone in Swedish specialized palliative care—Is it the magic bullet in complex cancer-related pain?

2020

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ContextDespite being associated with dependence and social stigma, methadone is a potential end-of-life option in complex cancer pain. ObjectivesTo explore attitudes and opinions about methadone and its potential role and current use in complex end-of-life pain. MethodsSemi-structured interviews (n = 30) with physicians in specialized palliative care, transcribed and analyzed with conventional qualitative content analysis. ResultsAccording to the physicians, patients and relatives expressed unexpectedly few negative attitudes, not affecting methadone's use as an analgesic. Complex pain in bone-metastatic cancer of the prostate, breast and kidney, as well as pancreatic cancer and sarcomas were recurrent suggestions of appropriate indications.Most of the informants stated that they applied a mechanism-based treatment and mainly prescribed low-dose methadone as an add-on to an existing opioid therapy to benefit from methadone´s proposed NMDA-receptor inhibiting properties, e.g. in cases with reduced opioid sensitivity. Despite its complex pharmacokinetics with a long half-life, most informants expressed defined strategies to avoid side-effects such as respiratory depression, especially when initiating treatment in the home-care setting.While many palliative care physicians expressed an overly enthusiastic attitude, others stressed the risks of overconfidence, low precision in use, and overlooked treatment options. Besides the obvious physical pain-relieving effects, they stated that effective pain relief could result in a reduced workload and emotional empowerment, both for physicians and staff.

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Section: Recommendations For Future Researchsupporting

confidence: 52%

Section: Methadonementioning

confidence: 99%

Methadone in Swedish specialized palliative care—Is it the magic bullet in complex cancer-related pain?

2020

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“…Previous studies on adjunctive methadone are limited by loss of follow-up or otherwise have not reported discontinuation rates, making it challenging to compare our discontinuation rates with those of others. [13][14][15] Another unique feature of our study is the demonstration that most patients reported improved sleep and mood, which play an important role in overall quality of life. Despite using ULD and gradual titration, existing opioid remained and methadone tissue saturation and alpha-1 globulin latching in circulation seem to have not affected the positive response of patients.…”

Section: Fig 1 Proportion Of Patients On Co-analgesic Medicationsmentioning

confidence: 74%

Ultralow-Dose Adjunctive Methadone with Slow Titration, Considering Long Half-Life, for Outpatients with Cancer-Related Pain

Chary

Abdul-Razzak

Galloway

2020

Palliative Medicine Reports

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Background: The unique properties of methadone make it attractive for use in cancer pain. The use of very low initial doses of adjunctive methadone is a promising strategy given its simplicity and potentially reduced risk profile. Objective: To understand if an ultralow-dose (ULD) methadone protocol (1 mg by mouth daily initial dose with gradual titration) can improve pain control in outpatients with cancer-related pain not responsive to previous opioids and/or nonopioid analgesics. We also sought to assess if the use of ULD methadone resulted in improvement in mood and sleep among other outcomes. Design and Setting/Subjects: This study is a retrospective chart review of outpatients at the cancer pain clinic at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. Measurements: The mean ratings in maximum and average pain before methadone initiation, and at the final follow-up point are reported. Paired sample t tests evaluate for statistically significant differences in pain ratings before methadone initiation and at final follow-up. We also report the proportion of participants with a subjective improvement in pain, sleep, and mood (dichotomous ''yes/no''), and the mean number of weeks to initial documented pain improvement. Results: 68.6% of patients (24/34) reported a subjective improvement in pain. Most patients reported improved sleep and mood (78.8% and 64.7%, respectively). Conclusions: More than two-thirds of patients reported an improvement in pain with a protocol using very low initial doses of adjunctive methadone. Our report is a preliminary retrospective chart review and larger prospective trials are warranted.

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“…The starting methadone dose (10 mg three times daily) and the final dose (15 mg three times daily) were higher than those reported by other authors who added methadone to the existing regular opioid regimen: a starting dose of 2.5-20 mg daily and a final dose of 5-30 mg daily (7), or 2.5-5 mg and 20 mg, respectively (8). Our more aggressive approach was associated with severe pain intensity observed in the patient (NRS 8) and higher morphine equivalent daily doses than those for patients treated in cited references (7,8).…”

Section: Discussionmentioning

confidence: 86%

Methadone as An Additional Opioid for A Cancer Patient with Severe Neuropathic and Bone Pain Not Responsive to Other Opioids and Adjuvant Analgesics

Leppert

Kowalski

2013

J Palliat Care

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Use of Methadone as a Coanalgesic

Cited by 17 publications

References 5 publications

Methadone in Swedish specialized palliative care—Is it the magic bullet in complex cancer-related pain?

Methadone in Swedish specialized palliative care—Is it the magic bullet in complex cancer-related pain?

Ultralow-Dose Adjunctive Methadone with Slow Titration, Considering Long Half-Life, for Outpatients with Cancer-Related Pain

Methadone as An Additional Opioid for A Cancer Patient with Severe Neuropathic and Bone Pain Not Responsive to Other Opioids and Adjuvant Analgesics

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