title: Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer.
abstract: Cancer pain is still inadequately treated in up to 60% of cancer patients. Based on the additional effect on the N-Methyl-d-Aspartate receptor, we expected that methadone (Met) could provide better pain relief than fentanyl (Fen) in cancer pain with a neuropathic pain component.
  
  
  
  A randomised controlled trial was performed with 52 strong opioids naive patients with head-and-neck cancer with substantial pain (pain Numerical Rating Scale [NRS] > 4) and a neuropathic pain component (Douleur Neuropathique [DN4] > 4). Twenty-six patients were treated with Met and 26 with Fen. Patients were evaluated at 1, 3 and 5 weeks. The primary outcomes were reduction in average pain, clinical success (defined as 50% average pain decrease) and reduction in pain interference. Secondary outcomes were global perceived effect (GPE) and side-effects.
  
  
  
  Reduction in NRS was higher with the use of Met at 1, 3 and 5 weeks (pain change 2.9, 3.1 and 3.1) compared to Fen (1.4, 1.7 and 2.0). This difference was significant at 1 (p = 0.011) and at 3 weeks (p = 0.03). Clinical success (>50% improvement) was higher with Met at 1 week (15% versus 50%, p = 0.012). The change in pain interference, the GPE and side-effect profile were not significantly different between the groups.
  
  
  
  This is the first study to compare the effects of Met to Fen in cancer patients with a neuropathic pain component. Based on the results of this study, Met should be considered in the treatment of oncological pain with a neuropathic component.
authors: University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Anaesthesiology and Pain Management, OLVG, Amsterdam, The Netherlands.
authors: J
authors: J
authors: Haumann
authors: University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: J W
authors: JW
authors: Geurts
authors: Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands.
authors: S M J
authors: SM
authors: van Kuijk
authors: Maastricht University Medical Centre, Department of Otorhinolaryngology, Head & Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors: B
authors: B
authors: Kremer
authors: University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, The Netherlands.
authors: E A
authors: EA
authors: Joosten
authors: University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: m.vanden.beuken@mumc.nl.
authors: M H J
authors: MH
authors: van den Beuken-van Everdingen
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000072716:Cancer Pain / Q000188:drug therapy*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone; D005283:Fentanyl
keywords: Cancer pain; Fentanyl; Head-and-neck cancer; Methadone; NMDA receptor antagonist