title: Characterization of the early pharmacodynamic profile of oral methadone for cancer-related breakthrough pain: a pilot study.
abstract: Methadone is effective for chronic cancer pain, but its early pharmacodynamic profile and effectiveness for breakthrough pain remain uncertain. This was an open-label, non-randomized, crossover study comparing the use of oral methadone for breakthrough pain with patients' usual opioid. Study variables included pain intensity (pretreatment and at 10-minute intervals post treatment), treatment-related side effects, and treatment satisfaction. In 37 discrete episodes of breakthrough pain, onset of analgesic effect of a titrated dose of oral methadone was rapid for all patients; 3 of 6 study patients experienced an onset of relief by 10 minutes post-ingestion. The adverse effect profile of oral methadone was not different from patients' usual 'rescue' opioid, and patients were moderately to completely satisfied with oral methadone as a breakthrough pain medication. These observations suggest that oral methadone can have a rapid onset of analgesic action and may have a legitimate role in the management of cancer-related breakthrough pain.
authors.affiliation: Alberta Cancer Board Palliative Research Initiative, Calgary, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Fisher
authors.forename: Carla
authors.initials: C
authors.lastname: Stiles
authors.forename: Neil A
authors.initials: NA
authors.lastname: Hagen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002908:Chronic Disease; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010166:Palliative Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010865:Pilot Projects; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone