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Severe cancer pain - adding methadone to other opioid treatment may help

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Jim Marshall (not a doctor) said …

Getting on top of pain is very important.

If the treatment you are on is not working, perhaps you can ask your doctor what they think about adding methadone.

… end Jim

J Palliat Med. 2013 Mar;16(3):305-9. doi: 10.1089/jpm.2012.0335. Epub 2013 Feb 7.

Addition of methadone to another opioid in the management of moderate to severe cancer pain: a case series.

Wallace E, Ridley J, Bryson J, Mak E, Zimmermann C.


Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.



Previous research has reported improved pain after adding methadone to another opioid, but did not quantify this benefit using a validated outcome measure.


To assess quantitatively the effectiveness of adding methadone to another opioid for moderate to severe cancer-related pain.


All outpatients attending the Oncology Palliative Care Clinic from September 2010-September 2011, who had received methadone, were identified from pharmacy records. Inclusion criteria included: histological diagnosis of malignancy, age >18 years, taking regular opioids and Edmonton Symptom Assessment System (ESAS) pain score ≥ 4.


The primary outcome measure was a decrease in pain score of ≥ 2 points from methadone initiation to one-month follow-up (or closest available ESAS).


Twenty patients were available for analysis, 16 of whom had neuropathic pain (80%). Eight patients (40%) had a decrease in pain score of ≥ 2 points at 1 month and a further 7 (35%) had a decrease of ≥ 2 points at the closest available time point. The mean pain score decreased from 7.7 +/- 1.8 to 5.2 +/- 2.4 from time of initiation to time of evaluation. The mean daily routine morphine equivalent, (excluding methadone), was 338 +/- 217.8 mg/day at initiation and 332 +/- 191 mg/day at evaluation; for methadone, mean doses at initiation and evaluation were 4.4 +/- 1.4 mg/day and 15.5 +/- 5.9 mg/day, respectively. Methadone was well tolerated in 17 patients (85%). Conclusions: The addition of methadone was associated with improved pain control for patients with moderate to severe pain on another opioid and appears to offer a safe, well-tolerated and practical alternative in this situation.

PMID: 23391350

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).


Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

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