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Methadone for cancer pain.

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Methadone offers similar pain relief to morphine for cancer patients but can be challenging to dose and may cause fatal arrhythmias. It is an option for those intolerant to other opioids, requiring experienced practitioners.

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Area of Science:

  • Oncology
  • Pain Management
  • Pharmacology

Background:

  • Methadone is a synthetic opioid used for cancer pain management.
  • It presents challenges in dose titration and carries a risk of fatal arrhythmias.
  • This review is part of a series on opioid analgesics for cancer pain.

Purpose of the Study:

  • To evaluate the effectiveness and tolerability of methadone for managing cancer pain in adults and children.
  • To compare methadone's analgesic properties against other pain relief options.

Main Methods:

  • Searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL, clinicaltrials.gov) up to May 2016.
  • Included randomized controlled trials comparing methadone with active or placebo comparators.
  • Extracted data on pain intensity, pain relief, and adverse events; assessed evidence quality using GRADE.

Main Results:

  • Six studies with 388 participants were included; no studies in children.
  • Methadone demonstrated similar effectiveness to morphine in achieving 'no worse than mild pain'.
  • Adverse event withdrawals were uncommon and similar across groups; somnolence was more frequent with methadone.

Conclusions:

  • Methadone provides comparable analgesic benefits to morphine for adult cancer pain, based on low-quality evidence.
  • It serves as a viable option when other opioids are not tolerated, though potentially more cost-effective.
  • Experienced practitioners should initiate methadone due to titration challenges and potential cardiac risks.