Oral Methadone for Cancer Pain Management at the End of Life: A Forgotten Drug

Oral Methadone for Cancer Pain Management at the End of Life: A Forgotten Drug

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Corresponding Author
Emma Verastegui-Aviles
National Cancer Institute, Palliative Care Service, Mexico

A B S T R A C T

Background: Opioids are used for pain management in cancer patients. Morphine is considered the best option. For some patients with pain of difficult control management and adverse effects, an opioid rotation should be considered. Oral methadone is an opioid to which patients can be rotated safely and effectively and inexpensive for Mexico and Latin America. Our study describes the 9-year experience of opioid rotation to methadone, the population profile, efficacy of methadone in cancer patients of the palliative care service. Methods: Retrospective study of cancer patients rotated to oral methadone for pain control. Tables of frequencies, median and interquartile ranges were made, as well as overall survival. Results: 311 patients were rotated to methadone, predominantly males (58.5%), median age of 54 years with oncological diagnoses in cervix (10.3%), germinal tumors (8.4%), breast (8.0%), prostate (7.4%) and rectal (5.5%). These patients experienced visceral (17.6%) or other types of pain (68.6%), and a combination of different types of pain, the most prevalent pain was neuropathic (88.7%) and 50% received morphine, 21% buprenorphine or fentanyl 19% previously, with a median dose of 60 mg (30-120). The main reason for rotation was difficult pain control (54%), obtaining an efficacy of 70.0%. Conclusion: In this cohort at advanced disease stage, 54% suffered from difficult pain control, thus rotation became necessary, reducing pain and manageable adverse events, without major changes of the initial and final dose. Should be promoted more widely in the management of pain of difficult control by cancer in first position prescription.

Article Info

Article Type
Research Article
Publication history
Received: Mon 29, Jun 2020
Accepted: Mon 13, Jul 2020
Published: Fri 31, Jul 2020
Copyright
© 2023 Emma Verastegui-Aviles . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.DDA.2020.01.03