Per Fürst1,2, Staffan Lundström1,2, Pål Klepstad3,4,5, Sara Runesdotter6, Peter Strang1,2. 1. 1 Department of Oncology-Pathology, Karolinska Institutet , Stockholm, Sweden . 2. 2 Palliative Medicine, Stockholms Sjukhem Foundation , Stockholm, Sweden . 3. 3 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim, Norway . 4. 4 European Palliative Research Center, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim, Norway . 5. 5 Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital , Trondheim, Norway . 6. 6 Medical Management Center, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet , Stockholm, Sweden .
Abstract
BACKGROUND: Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy. OBJECTIVE: To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain. DESIGN: This was a retrospective chart review. SETTING/ SUBJECTS: All patients with advanced cancer treated in a specialized palliative care unit who had received oral methadone in addition to another regular opioid were identified. MEASUREMENTS: Intensity of pain, opioid doses, and occurrence of sedation, delirium, and respiratory depression were obtained from the patients' medical records for a period of one week after initiation of methadone. RESULTS: Eighty patients were included. The median daily methadone dose was 10 mg during the treatment period. Eighty percent of the patients had improved pain control (p < 0.001). There was an increased risk for sedation and delirium, most pronounced in patients living 14 days or less after the start of methadone. No patient experienced respiratory depression. CONCLUSION: Addition of low-dose oral methadone to regular high-dose opioid treatment in cancer patients with complex pain close to death improves pain control, but also increases the risk for sedation and delirium.
BACKGROUND:Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy. OBJECTIVE: To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain. DESIGN: This was a retrospective chart review. SETTING/ SUBJECTS: All patients with advanced cancer treated in a specialized palliative care unit who had received oral methadone in addition to another regular opioid were identified. MEASUREMENTS: Intensity of pain, opioid doses, and occurrence of sedation, delirium, and respiratory depression were obtained from the patients' medical records for a period of one week after initiation of methadone. RESULTS: Eighty patients were included. The median daily methadone dose was 10 mg during the treatment period. Eighty percent of the patients had improved pain control (p < 0.001). There was an increased risk for sedation and delirium, most pronounced in patients living 14 days or less after the start of methadone. No patient experienced respiratory depression. CONCLUSION: Addition of low-dose oral methadone to regular high-dose opioid treatment in cancerpatients with complex pain close to death improves pain control, but also increases the risk for sedation and delirium.
Entities:
Keywords:
cancer pain; delirium; methadone; opioid; palliative care; sedation