Methadone response in advanced cancer patients with pain followed at home

Concerns about the safety of therapy with methadone which may arise because of its pharmacokinetic characteristics and inappropriate dosing, may deter clinicians from using this drug, especially in elderly patients. Experienc e is accumulating that the drug may ire used safely and successfully if low doses are given initially and care is taken in the titration of the dose a gainst the pain. A prospective study was carried out in a consecutive sampl e of 45 advanced cancer patients followed at home, who had never received o ther strong opioids for their pain. Patients were treated with an oral liqu id preparation of methadone, which was,ns administered 2-3 times daily, acc ording to need. Doses were kept as low as possible and were titrated to ach ieve acceptable analgesia with minimal adverse effects. The methadone start ing dose (MSD) at referral, the maximum dose of methadone (MMD), the days o f methadone treatment, the use of other nonopioid analgesics, symptoms asso ciated with methadone therapy, pain intensity, and pain mechanism were reco rded. Methadone escalation index percentage (MEI%) and methadone escalation index in mg (MEI mg) were calculated from these parameters. No correlation s between age and gender; and MSD, MMD, days on methadone, VAS and symptoms were found. No significant differences were found in pain mechanisms, age, and other parameters, including methadone-related symptoms. Treatment of p ain with methadone provides important support to patients with cancer follo wed at home and the risks are low with individually titrated doses, even in older patients or in the presence of a neuropathic pain mechanism. (C) U.S . Cancer Pain Relief Committee, 1999.