Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled study

Area of Science:

• Oncology
• Pain Management
• Pharmacology

Background:

• Refractory cancer-induced bone pain (CIBP) significantly impairs patient function and quality of life.
• Limited evidence exists to guide optimal opioid selection for managing CIBP.
• This study addresses the need for evidence-based strategies in CIBP management.

Purpose of the Study:

• To assess the feasibility, tolerability, and potential efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in patients with refractory CIBP.
• To evaluate patient outcomes following opioid rotation for cancer pain.
• To provide preliminary data for future large-scale studies on opioid management in CIBP.

Main Methods:

• A randomized controlled trial comparing MR to OOR in adult patients with CIBP.
• Participants had worst pain intensity ≥4/10 or opioid toxicity grade ≥2.
• Standardized assessments were conducted up to 14 days post-rotation.

Main Results:

• Of 51 eligible participants, 29 completed the 14-day follow-up.
• Both MR and OOR groups showed significant reductions in average and worst pain intensity, and total pain interference scores.
• The daily oral morphine equivalent dose was significantly reduced in the MR group compared to the OOR group. Opioid-related adverse events were lower in the OOR group.

Conclusions:

• Methadone rotation and other opioid rotations are feasible, safe, and acceptable for patients with refractory CIBP.
• Both strategies demonstrated efficacy in reducing pain and improving pain interference.
• Further large-scale, multi-center randomized controlled trials are warranted to confirm the efficacy of MR and OOR in this patient population.