title: The use of methylphenidate in patients with incident cancer pain receiving regular opiates. A preliminary report.
abstract: In this open, uncontrolled trial, 15 patients with severe incident cancer pain receiving regular opiates were administered 10 mg oral methylphenidate (MP) at 08.00 h and 15 mg at 12.00 h in order to antagonize opiate-induced sedation. The daily dose of opiate was increased by 30% 24 h after starting MP, followed by a 10% increase twice a day until maximal tolerated dose. In 14 evaluable patients, pain (VAS 0-100 mm), sedation (VAS), and mean equivalent daily dose (MEDD) of morphine were 55 +/- 17, 65 +/- 18 and 248 +/- 150 48 h before MP, versus 38 +/- 12 (P less than 0.01), 42 +/- 12 (P less than 0.01), and 405 +/- 130 (P less than 0.01) 48 h after MP, respectively. After 48 h of treatment, 12 of 14 patients felt better on MP, 2 of 12 patients felt no difference, and no patients felt worse (P less than 0.05). We conclude that the addition of MP allowed for an increase in the MEDD of morphine and increased pain control. Controlled double-blind trials should be performed.
authors.affiliation: Palliative Care Program, Edmonton General Hospital, University of Alberta, Department of Epidemiology, Cross Cancer Institute, Edmonton, Alberta T5K 0LA Canada.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Robin
authors.initials: R
authors.lastname: Fainsinger
authors.forename: Tara
authors.initials: T
authors.lastname: MacEachern
authors.forename: John
authors.initials: J
authors.lastname: Hanson
mesh_terms: D006801:Humans; D006993:Hypnotics and Sedatives / Q000037:antagonists & inhibitors*; D008774:Methylphenidate / Q000627:therapeutic use*; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000188:drug therapy*; D010166:Palliative Care; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D008774:Methylphenidate