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CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(06): 530-535
DOI: 10.1055/s-0044-1787831
Brief Communication

Chart Review and Practical Recommendations for the Use of Methadone as an Alternative to Opioid Rotation in the Management of Cancer-Related Pain

Arunangshu Ghoshal 
1   Department of Supportive Care, University Health Network, University of Toronto, Toronto, Ontario, Canada
2   Department of Palliative Medicine, Tata Memorial Center, Homi Bhaba National Institute, Mumbai, Maharashtra, India
,
Anuja Damani 
2   Department of Palliative Medicine, Tata Memorial Center, Homi Bhaba National Institute, Mumbai, Maharashtra, India
3   Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Raghu Thota 
2   Department of Palliative Medicine, Tata Memorial Center, Homi Bhaba National Institute, Mumbai, Maharashtra, India
,
P. N. Jain
2   Department of Palliative Medicine, Tata Memorial Center, Homi Bhaba National Institute, Mumbai, Maharashtra, India
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Abstract

Introduction Palliative care, with a focus on enhancing the quality of life for individuals facing life-limiting illnesses, relies on effective pain management as a fundamental component. Opioids, particularly methadone, play a crucial role in addressing moderate to severe pain in palliative care due to their unique pharmacological properties. Methadone, a long-acting opioid agonist and N-methyl-D-aspartate receptor antagonist, is valuable for treating both nociceptive and neuropathic pain. However, the transition to methadone from other opioids requires careful consideration.

Objectives This study examines the use of methadone as an alternative to morphine or fentanyl for managing refractory cancer pain in a tertiary care hospital in India.

Methods We conducted a retrospective analysis of anonymized medical records of cancer patients initiated on oral methadone for pain management at a tertiary cancer center's palliative medicine outpatient clinic from February 2020 to June 2021. Data included demographic characteristics, pain descriptions, concurrent analgesic use, reasons for transitioning to methadone, rotation methods, methadone dosages, clinical outcomes, adverse effects, and treatment discontinuations. Patients were routinely followed up, with pain scores, morphine equivalent daily doses, and methadone requirements recorded at each visit.

Results Forty-four patients received methadone, either as a coanalgesic (41/44) or primary opioid (3/44). Refractory cancer pain, with a neuropathic component, was the predominant indication for methadone use. Following the methadone initiation, all patients experienced significant pain relief. Median daily methadone dose increased from 5 to 7.5 mg after 1 week. Adverse effects were minimal, with one patient experiencing QTc interval prolongation. Patient-specific factors often necessitated deviations from equianalgesic conversion tables in determining methadone dosages.

Conclusion Methadone offers a viable option for refractory cancer pain when conventional treatments fall short. Physicians should prioritize personalized titration and thorough assessment during opioid rotation, rather than relying solely on conversion tables. Further research is needed to explore alternative approaches for opioid rotation and to expand our understanding of methadone's optimal use in cancer pain management.

Keywords

methadone - cancer pain - opioid rotation - equianalgesic conversion - pain relief - side effects

Disclosure

The responsibility for the writing and content of the article lies solely with the author.


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Publication History

Article published online:
18 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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