J Haumann1, J W Geurts2, S M J van Kuijk3, B Kremer4, E A Joosten5, M H J van den Beuken-van Everdingen6. 1. University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Anaesthesiology and Pain Management, OLVG, Amsterdam, The Netherlands. 2. University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands. 3. Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands. 4. Maastricht University Medical Centre, Department of Otorhinolaryngology, Head & Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands. 5. University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, The Netherlands. 6. University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: m.vanden.beuken@mumc.nl.
Abstract
BACKGROUND:Cancer pain is still inadequately treated in up to 60% of cancer patients. Based on the additional effect on the N-Methyl-d-Aspartate receptor, we expected that methadone (Met) could provide better pain relief than fentanyl (Fen) in cancer pain with a neuropathic pain component. METHODS: A randomised controlled trial was performed with 52 strong opioids naive patients with head-and-neck cancer with substantial pain (pain Numerical Rating Scale [NRS] > 4) and aneuropathic pain component (Douleur Neuropathique [DN4] > 4). Twenty-six patients were treated with Met and 26 with Fen. Patients were evaluated at 1, 3 and 5 weeks. The primary outcomes were reduction in average pain, clinical success (defined as 50% average pain decrease) and reduction in pain interference. Secondary outcomes were global perceived effect (GPE) and side-effects. FINDINGS:Reduction in NRS was higher with the use of Met at 1, 3 and 5 weeks (pain change 2.9, 3.1 and 3.1) compared to Fen (1.4, 1.7 and 2.0). This difference was significant at 1 (p = 0.011) and at 3 weeks (p = 0.03). Clinical success (>50% improvement) was higher with Met at 1 week (15% versus 50%, p = 0.012). The change in pain interference, the GPE and side-effect profile were not significantly different between the groups. INTERPRETATION: This is the first study to compare the effects of Met to Fen in cancer patients with a neuropathic pain component. Based on the results of this study, Met should be considered in the treatment of oncological pain with a neuropathic component.
RCT Entities:
BACKGROUND:Cancer pain is still inadequately treated in up to 60% of cancerpatients. Based on the additional effect on the N-Methyl-d-Aspartate receptor, we expected that methadone (Met) could provide better pain relief than fentanyl (Fen) in cancer pain with a neuropathic pain component. METHODS: A randomised controlled trial was performed with 52 strong opioids naive patients with head-and-neck cancer with substantial pain (pain Numerical Rating Scale [NRS] > 4) and a neuropathic pain component (Douleur Neuropathique [DN4] > 4). Twenty-six patients were treated with Met and 26 with Fen. Patients were evaluated at 1, 3 and 5 weeks. The primary outcomes were reduction in average pain, clinical success (defined as 50% average pain decrease) and reduction in pain interference. Secondary outcomes were global perceived effect (GPE) and side-effects. FINDINGS: Reduction in NRS was higher with the use of Met at 1, 3 and 5 weeks (pain change 2.9, 3.1 and 3.1) compared to Fen (1.4, 1.7 and 2.0). This difference was significant at 1 (p = 0.011) and at 3 weeks (p = 0.03). Clinical success (>50% improvement) was higher with Met at 1 week (15% versus 50%, p = 0.012). The change in pain interference, the GPE and side-effect profile were not significantly different between the groups. INTERPRETATION: This is the first study to compare the effects of Met to Fen in cancerpatients with a neuropathic pain component. Based on the results of this study, Met should be considered in the treatment of oncological pain with a neuropathic component.