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Initiation of methadone was effective and safe as the first long-acting opioid in children with pain.

224 Background: Methadone is an attractive medication for treating children with advanced cancer who have chronic pain, as it is the only long-acting opioid available as a liquid. This formulation allows for precise dosing that is not possible with the fixed dose of extended release tablets or transdermal patches. Additionally, it can be used in children unable to reliably swallow tablets. Many pediatric oncologists are concerned with methadone’s complex pharmacodynamics and pharmacokinetics, and so it is often relegated to being the long-acting opioid to use only after long-acting morphine, long-acting oxycodone, and fentanyl transdermal patches have proven to be ineffective in controlling pain. We believe that methadone has a role as the first long-acting opioid in children who have uncontrolled pain while only on immediate-release mu opioid agonists. Methods: Retrospective chart review of 52 consecutive patients referred to Pediatric Supportive Care for pain management started on methadone as their first long-acting opioid. Data collected at baseline and first follow up visit (F1) included child- and parent-reported outcomes for various physical and psychological symptoms, opioid side effects and other clinical data. All symptoms were rated on a 5 point scale: 0 (not at all), 1 (a little bit), 2 (kind of), 3 (quite a bit) and 4 (a lot). Results: Of 52 eligible patients, a majority (47, 90.3%) were assessed at F1. Reasons for not evaluating patients at F1 included death (3) (none died of cardiac arrhythmia or opioid related toxicity) and transfer of care to another facility (2). Pain as scored by the child was 3.6/4 at baseline and 1.8/4 at F1 (P < 0.0001). Pain as scored by the parent was 3.5/4 at baseline and 1.4 at F1 (P < 0.0001). A majority of patients (33, 70.2%) at F1 did not need a change in their methadone dose. A small number (10, 21.3%) needed an increase in their methadone dose due to inadequate pain control; a few (4, 8.5%) had a lower methadone dose but all were part of tapering methadone due to resolution of the original pain syndrome, not due to opioid toxicity. Conclusions: Initiation of methadone was effective and safe as the first long-acting opioid in children with pain due to advanced cancer.