Clinical Evaluation of Oral Methadone in Treatment of Cancer Pain

Abstract

A dose-adjustment program for oral methadone and the long-term effects of the analgesic therapy have been evaluated in 15 patients with incurable cancer. Rapid and continuous pain reliefwithout serious side-effects was achieved by "ad libitum" dosage in the first 3-5 days. Thereafter, a dosage based on each patient's subjective need was instituted. The mean daily dose was 44 mg during the first day and it decreased to 22 mg daily at the end of the dose-adjustment week. Three patients did not complete the program because of insufficient effect or severe nausea. Among the 12 patients who chose to continue the methadone treatment after the initial doseadjustment period, four continued the therapy to their death, three discontinued the therapy due to insullicient effect, and three due to adverse reactions. In one case it was possible to stop the treatment due to decreased pain. The treatment period in these 12 patients varied between 8 and 270 days. Oral methadone offers good pain relief for long periods of time in this group of patients and has obvious advantages as compared to long term parenteral therapy with narcotic analgesics.

Effects of the kappa opioid agonist U50,488 and the kappa opioid antagonist nor-binaltorphimine on choice between cocaine and food in rhesus monkeys

“…Third, continuous treatment with these same doses of U50,488 did not decrease food-maintained responding more than cocaine-maintained responding when the two reinforcers were available separately in alternating sessions (Negus et al 1997). Fourth, it is well-established that mu opioid receptor agonists produce nausea and emesis in humans (Cepeda et al 2003;Hansen et al 1982), and, as with U50,488, pseudo-continuous infusion with the mu opioid receptor agonist methadone decreased response rates in rhesus monkeys choosing between food and cocaine; however, methadone did not alter cocaine choice in this procedure (Negus and Mello 2004). Finally, lithium chloride produces emesis in non-human primates (Verbalis et al 1987), but chronic treatment with lithium chloride did not increase choice of cocaine over food in rhesus monkeys, and some decreases in cocaine choice (and increases in food choice) were observed (Woolverton and Balster 1979).…”

The role of methadone in cancer pain treatment - a review

“…In an open study, 45 patients were treated with oral liquid preparation of methadone administered 2–3 times daily and followed up at home; methadone was well tolerated and did not cause serious adverse effects (119). In another open study, oral methadone proved to be effective and well tolerated in 12 of 15 patients who continued long‐term therapy without serious side effects; three patients withdrew because of nausea (2) and confusion (1) (120).…”

Development of a methadone order form for inpatients

“…14,16,18,19 A pain or palliative care consultation would be required for doses exceeding 20 mg daily, dosing schedules more frequent than every 8 hours, or any orders that did not meet the criteria set forth in the order form. Ask patients about adverse effects prior to increasing their methadone dose.…”