The objective is to understand if the use of a ULD methadone protocol can improve pain control in outpatients with cancer-related pain not responsive to previous opioid and/or nonopioid analgesic treatments. 11 Our study looks at a relatively unique protocol that starts at “ultralow doses” (ULDs) of 1 mg once daily with a slowly titrated regimen thereafter. 10 The use of very low initial doses of adjunctive methadone is a promising strategy given its simplicity, potentially reduced risk profile and the addition of a drug with unique properties that are not offered by other opioids.Ī 2019 systematic review found only seven studies on the use of low-dose methadone, with variable dosing strategies. 6–9 Although these methods are used in inpatient palliative care settings, they may be associated with unstable pain control in the transition period, sedation, and narcosis, and usually require inpatient monitoring. Present evidence-supported methods for use of methadone involve complete rotations off previous opioids and onto relatively high doses of methadone as the sole opioid. 2 The unique properties of methadone, namely NMDA antagonism and serotonergic and norepinephrine activity, make it a promising drug for use in cancer pain. The racemic mixture has a long and highly variable half-life of 7–150 hours.
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R-methadone has mu and delta agonist opioid properties, whereas S-methadone is an N-methyl- d-aspartate (NMDA) antagonist and a serotonin and norepinephrine reuptake inhibitor as nonopioid properties. Methadone is a synthetic opioid that was first produced in the 1930s 1 and is available as a racemic mixture comprising two enantiomers, R and S, each exhibiting unique properties.
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Our report is a preliminary retrospective chart review and larger prospective trials are warranted. Most patients reported improved sleep and mood (78.8% and 64.7%, respectively).Ĭonclusions: More than two-thirds of patients reported an improvement in pain with a protocol using very low initial doses of adjunctive methadone. Results: 68.6% of patients (24/34) reported a subjective improvement in pain. We also report the proportion of participants with a subjective improvement in pain, sleep, and mood (dichotomous “yes/no”), and the mean number of weeks to initial documented pain improvement. Paired sample t tests evaluate for statistically significant differences in pain ratings before methadone initiation and at final follow-up.
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Measurements: The mean ratings in maximum and average pain before methadone initiation, and at the final follow-up point are reported. We also sought to assess if the use of ULD methadone resulted in improvement in mood and sleep among other outcomes.ĭesign and Setting/Subjects: This study is a retrospective chart review of outpatients at the cancer pain clinic at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. Objective: To understand if an ultralow-dose (ULD) methadone protocol (1 mg by mouth daily initial dose with gradual titration) can improve pain control in outpatients with cancer-related pain not responsive to previous opioids and/or nonopioid analgesics. The use of very low initial doses of adjunctive methadone is a promising strategy given its simplicity and potentially reduced risk profile. Background: The unique properties of methadone make it attractive for use in cancer pain.