Methadone as the Initial Long-Acting Opioid in Children with Advanced Cancer

Madden, Kevin; Mills, Sarah; Dibaj, Seyedeh; Williams, Janet L.; Liu, Diane; Bruera, Éduardo

doi:10.1089/jpm.2017.0712

Cited by 23 publications

(23 citation statements)

References 26 publications

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“…When used early in the course of cancer pain, pain scores significantly improved on methadone initiation which led to improved insomnia extending into later follow-up visits. [ 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

“…Most paediatric palliative care providers preferred equianalgesic dosing with dose reduction rather than weight based formulae with methadone switchover whereas preferring weight based formula for methadone dose initiation in opioid naiïve children. [ 16 ] Although World health organization recommends weight based dosing in methadone loading doses defined by increasing initial frequency, American pain society doesn't recommend loading dose citing safety as primary concern. [ 43 55 ] There are no published reports of methadone induced severe dysrhythmia in paediatric pain practice.…”

Section: Discussionmentioning

confidence: 99%

“…[ 43 55 ] There are no published reports of methadone induced severe dysrhythmia in paediatric pain practice. [ 15 16 17 20 56 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 12 13 14 ] Being also available in a liquid preparation, it was more acceptable in paediatric pain. [ 15 16 17 18 19 20 ] The complexity of pain in terminal cancer and need for improving quality of life paved way for its use in end of life care. [ 7 8 13 21 ] The journey of methadone in cancer pain which had its initial safety reservation and prescription concerns, to overcoming the stigmatic barriers has been the subject for its review.…”

Section: Introductionmentioning

confidence: 99%

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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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“…When used early in the course of cancer pain, pain scores significantly improved on methadone initiation which led to improved insomnia extending into later follow-up visits. [ 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[ 43 55 ] There are no published reports of methadone induced severe dysrhythmia in paediatric pain practice. [ 15 16 17 20 56 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Methadone in Cancer Pain

Ramkiran

Thota

2020

Indian J Palliat Care

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“…Short acting agents should be 10-15% of the daily opioid morphine equivalent dose and given every 2-4 hours as needed. Methadone is a very useful long acting mu-agonist and NMDA antagonist 71 agent available in a variety of forms for easy pediatric dosing. Consultation with a provider comfortable with dosing and management may be necessary.…”

Section: Painmentioning

confidence: 99%

Palliative Care for Children with Central Nervous System Malignancies

Baenziger

Moody

2018

Preprint

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Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary palliative care

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