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Methadone for cancer pain.
1West Midlands Deanery, Compton Hospice, Compton Road West, Wolverhampton, UK, WV3 9DH.
The Cochrane Database of Systematic Reviews
|April 24, 2004
Summary
Methadone shows similar efficacy to morphine for cancer pain, but its long-term safety is uncertain due to limited trial data. Careful monitoring by experienced clinicians is crucial for managing methadone analgesia.
Area of Science:
- Palliative Care
- Pain Management
- Pharmacology
Background:
- Methadone is an opioid analgesic used for cancer pain, with potential in neuropathic pain.
- Evidence-based palliative care necessitates evaluating methadone against other analgesics.
Purpose of the Study:
- To assess the effectiveness and safety of methadone for cancer pain management.
Main Methods:
- Searched multiple databases (MEDLINE, EMBASE, CancerLit, CINAHL, Cochrane) for randomized controlled trials (RCTs) up to August 2002.
- Included RCTs comparing methadone to active or placebo comparators in cancer pain patients, focusing on pain reduction, adverse effects, and quality of life.
- Extracted data on drug dosage, titration, route, formulation, and outcomes; quality assessment was performed.
Main Results:
- Eight RCTs (356 patients) were included, with five double-blind and two crossover designs.
- All trials used active placebos (morphine, dextromoramide, pethidine, diamorphine with cocaine mixture).
- Adverse event profiles were similar to morphine, but limited data prevented meta-analysis or differentiation by cancer pain syndrome.
Conclusions:
- Methadone appears to have comparable efficacy and side effect profile to morphine for cancer pain.
- Short-term studies and single-dose comparisons do not fully represent clinical practice, posing risks of methadone accumulation and delayed adverse effects.
- No evidence supports methadone's specific role in malignant neuropathic pain; experienced clinicians are essential for safe management due to complex pharmacokinetics.