Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.
OBJECTIVE
To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain.


METHODS
Patients in international palliative care clinics with pain requiring initiation of strong opioids were randomly assigned to receive methadone (7.5 mg orally every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained release every 12 hours and 5 mg every 4 hours as needed). The study duration was 4 weeks.


RESULTS
A total of 103 patients were randomly assigned to treatment (49 in the methadone group and 54 in the morphine group). The groups had similar baseline scores for pain, sedation, nausea, confusion, and constipation. Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%) than those receiving morphine (three of 54; 6%; P =.019). The opioid escalation index at days 14 and 28 was similar between the two groups. More than three fourths of patients in each group reported a 20% or more reduction in pain intensity by day 8. The proportion of patients with a 20% or more improvement in pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of patient-reported global benefit were nearly identical to the pain response rates and did not differ between the treatment groups.


CONCLUSIONS
Methadone did not produce superior analgesic efficiency or overall tolerability at 4 weeks compared with morphine as a first-line strong opioid for the treatment of cancer pain.
Bruera
Eduardo
E
Department of Palliative Care & Rehabilitation Medicine (Unit 0008), the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-0049, USA. Ebruera@mail.mdanderson.org
Palmer
J Lynn
JL
Bosnjak
Snezana
S
Rico
Maria Antonieta
MA
Moyano
Jairo
J
Sweeney
Catherine
C
Strasser
Florian
F
Willey
Jie
J
Bertolino
Mariela
M
Mathias
Clarissa
C
Spruyt
Odette
O
Fisch
Michael J
MJ
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010166:Palliative Care; D010352:Patient Dropouts; D017060:Patient Satisfaction
D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D008691:Methadone