Evaluating Methadone as Treatment for Refractory Cancer-Induced Bone Pain

This retrospective chart review aimed to evaluate the effectiveness of methadone for cancer-induced bone pain (CIBP) in inpatient and outpatient settings. The primary objective of this study was to analyze the change in pain scores utilizing the numeric rating scale (NRS) after 28 days of receiving methadone therapy compared to previous failed opioids trialed. Secondary objectives included assessing the daily total morphine milliequivalent (MME) of breakthrough opioid medications required, change in Eastern Cooperative Oncology Group (ECOG) and Palliative Performance Scale (PPS) scores before and after the initiation of methadone. Twenty-seven patients with CIBP received at least twenty-eight days of methadone between January 2020 and August 2024. Reported pain scores utilizing the NRS prior to the initiation of methadone and after at least twenty-eight days of methadone therapy were 7 (IQR 5,8) and 4 (IQR 4,5) respectively (p = 0.013). Reported amount of breakthrough MME prior to methadone and after twenty-eight days of methadone were 90 MME and 31 MME respectively (p = 0.021). No change was seen in ECOG or PPS scores before [1.0 ± 1.02]; (70% (IQR 60%,80%]) and after [1.5 ± 0.831]; (70% (IQR 60%,80%)) methadone, respectively (p = 0.104); (p = 0.855). Methadone demonstrated effectiveness in reducing pain and the amount of breakthrough medication needed in patients with CIBP.