title: Methadone rotation for cancer patients with refractory pain in a palliative care unit: an observational study.
abstract: BACKGROUND
  Methadone has been reported to be as effective as morphine for cancer pain management. It is commonly used as an alternative opioid in case of insufficient relief.
  
  
  OBJECTIVE
  Our aim was to assess efficacy and tolerance of opioid rotation to methadone for refractory cancer pain management in palliative care unit (PCU) inpatients.
  
  
  METHODS
  All the patients undergoing opioid rotation to methadone from 2008 to 2011 in two PCUs (Lyon and Nice, France) were included. Pain assessments were undertaken on day 0 (D0), day 3 (D3), day 7 (D7), and day 14 (D14) using a visual analogue scale (VAS; 0-10) and the Douleur Neuropathique 4 (DN4) scale for neuropathic pain. Patients reported pain relief using a 4-point Likert scale (1=no relief; 4=important relief ).
  
  
  RESULTS
  Nineteen patients (7 females) with a median age of 55 (Q1-Q3; 44-58) underwent methadone rotation. The most common type of cancer was gastrointestinal. Seventeen patients had a diagnosis of mixed pain syndromes. Morphine equivalent daily dose (MEDD) prior to switching was 480 mg (Q1-Q3; 100-1021), and at least two nonmethadone opioid rotations had already been done for 13 patients. Between D0 and D7, the VAS score decreased by 4 points (p<0.001). The DN4 score became negative on D7 for 11 of 17 patients (65%). On D7, 16 of 18 patients (89%) expressed moderate to greater than moderate pain relief. Methadone was discontinued in one patient on D7 because it was deemed ineffective and for 8 patients, who were unable to take oral drugs, it was discontinued after D14.
  
  
  CONCLUSIONS
  Our results suggest that methadone is effective and well tolerated for refractory cancer pain.
authors.affiliation: 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France .
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.forename: Flora
authors.initials: F
authors.lastname: Tremellat
authors.forename: Mathilde
authors.initials: M
authors.lastname: Ledoux
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ciais
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Marilene
authors.initials: M
authors.lastname: Filbet
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology*; D010166:Palliative Care; D012189:Retrospective Studies; D013810:Therapeutic Equivalency; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone