Use of Methadone for Uncontrolled Pain: An Alternative Dosing Regimen

Walmsley, Rowan; Robson, Peter; Lee, Mark Andrew

doi:10.1016/j.jpainsymman.2010.09.003

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Typically, the introduction of methadone to a patient's regimen is done as part of a switch from another opioid. One of the most commonly used regimens is that described by Morley and Makin, 1 with an alternative method recently suggested by Walmsley et al 2 These methods can be complex and often require hospice inpatient stay for safe initiation and titration. Methadone is known to have an affinity for m, d, and K opioid receptors; to be an N-methyl-D-aspartate (NMDA) receptor antagonist; and to inhibit reuptake of serotonin and norepinephrine.…”

Section: Use Of Methadone As a Coanalgesicmentioning

confidence: 99%

“…College of Chest Physicians in 2008. 2 Although a meta-analysis recently suggested a positive effect of prophylactic doses of LMWH on overall survival in patients with advanced cancer, 3 this effect has not been proven and does not concern palliative care patients a priori, as the main outcome goal of palliative care is not improving survival but preserving quality of life. On the other hand, this meta-analysis probably explains in part the increasing proportion of patients arriving in palliative care with LMWH thromboprophylaxis, as observed by Legault et al…”

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confidence: 99%

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Use of Methadone as a Coanalgesic

McKenna

Nicholson²

2011

Journal of Pain and Symptom Management

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Section: Use Of Methadone As a Coanalgesicmentioning

confidence: 99%

mentioning

confidence: 99%

Use of Methadone as a Coanalgesic

McKenna

Nicholson²

2011

Journal of Pain and Symptom Management

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“…Several authors suggested different protocols. All proposals are safe and efficient for pain relief [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Early Use of Methadone for Cancer Pain

Treillet¹

2018

J Cancer Sci Clin Ther

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Methadone has been known since the beginning of the 20th century. Its use for cancer pain is still controverted.Several articles clearly show the benefit of methadone for cancer pain. We attempted to identify the advantages of use of methadone early on in the course of cancer. Methadone is a very interesting molecule for cancer pain treatment because of anti NMDA, SSRI and opioid actions, lack of active metabolite, and cost. Its benefits must be balanced against the potential drug to drug interactions during treatment initiation and interactions with other drugs when methadone doses are stable. As for all opioids, side effects can appear. Ten studies including 706 patients support the use of methadone as first line opioid treatment: 7 are prospective studies (one double-blind randomized with morphine, 4 randomized controlled with morphine or transdermal fentanyl, two open studies) and 3 are retrospective studies. Seven studies support its ambulatory initiation (3 prospective including 2 controlled studies, and 4 retrospective studies) with a total of 845 patients. Methadone could be used with caution early on in cancer pain management.

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Methadone for chronic non-cancer pain in adults

Haroutounian¹,

McNicol

Lipman

2012

Cochrane Database of Systematic Reviews

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BackgroundMethadone belongs to a class of analgesics known as opioids, that are considered the cornerstone of therapy for moderate-to-severe pain due to life-threatening illnesses; however, their use in chronic non-cancer pain (CNCP) is controversial. Methadone has many characteristics that di erentiate it from other opioids, which suggests that it may have a di erent e icacy and safety profile. ObjectivesTo assess the analgesic e ectiveness and safety of methadone in the treatment of CNCP. Search methodsWe identified both randomized controlled trials (RCTs) and non-randomized studies of methadone use in chronic pain by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2011, issue 11, MEDLINE (1950 to November 2011), and EMBASE (1980 to November 2011, together with reference lists of retrieved papers and reviews. Selection criteriaWe included RCTs with pain assessment as either the primary or secondary outcome. Quasi-randomized studies, cohorts and case-control trials were also considered for inclusion because we suspected that the beneficial and harmful e ects of methadone in CNCP may not be adequately addressed in RCTs. Data collection and analysisTwo review authors independently extracted e icacy and adverse event data and assessed risk of bias. Main resultsWe included two RCTs and one non-randomized study, involving a total of 181 participants. Both RCTs were cross-over studies, one involving 19 participants with diverse neuropathic pain syndromes, the other involving 76 participants with postherpetic neuralgia. Study phases were 20 days and approximately eight weeks, respectively. The non-randomized study retrospectively evaluated 86 outpatients over an average of 8.8 ± 6.3 months.One RCT reported average pain intensity and pain relief, and found statistically significant improvements versus placebo for both outcomes, with 10 mg and 20 mg daily doses of methadone. The second RCT reported di erences in pain reduction between methadone and morphine and found morphine to be statistically superior. The non-randomized study found that in patients initially prescribed methadone it was Methadone for chronic non-cancer pain in adults (Review)

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Use of Methadone for Uncontrolled Pain: An Alternative Dosing Regimen

Cited by 6 publications

References 3 publications

Use of Methadone as a Coanalgesic

Use of Methadone as a Coanalgesic

Early Use of Methadone for Cancer Pain

Methadone for chronic non-cancer pain in adults

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