Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study
Female; Humans; Male; Analgesics; Prospective Studies; Middle Aged; Drug Administration Schedule; Non-U.S. Gov't; Research Support; Administration; Oral; Pain/drug therapy; Neoplasms/complications; Methadone/administration & dosage/pharmacology; Morphine/adverse effects/pharmacology; Opioid/administration & dosage/adverse effects/pharmacology
PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P <.005) and an average of a 33% increase in methadone doses necessary (P <.01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P <.0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P <.0005), nausea and vomiting (P <.03), constipation (P <.001), and drowsiness (P <.01), but a significant increase in the methadone dose of an average of 20% (P <.004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.
2001
Mercadante S; Casuccio A; Fulfaro F; Groff L; Boffi R; Villari P; Gebbia V; Ripamonti C
Journal Of Clinical Oncology
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1200/jco.2001.19.11.2898" target="_blank" rel="noreferrer">10.1200/jco.2001.19.11.2898</a>
Patient-controlled analgesia with oral methadone in cancer pain: preliminary report
Female; Humans; Male; Analgesics; Aged; Middle Aged; Analgesia; Administration; Oral; Dose-Response Relationship; Drug; Neoplasms/complications; Patient-Controlled; Methadone/administration & dosage/adverse effects/blood; Opioid/administration & dosage/adverse effects/blood; Pain/etiology/prevention & control
BACKGROUND: Methadone is a very useful drug in cancer pain because of its low cost, lack of active metabolites, high oral availability, and the rapid onset of its analgesic effect. It seems to be well tolerated in patients with difficult pain syndromes who are receiving high doses of opioids, and it may deter the development of tolerance, but a high individual variation in terminal elimination half-life can result in different rates and extents of drug accumulation. For this reason, oral patient-controlled analgesia with methadone was used in 24 advanced-disease patients with pain. PATIENTS AND METHODS: A regimen of self-administered oral methadone at fixed doses and flexible patient-controlled dosage intervals to achieve adequate analgesia, while avoiding toxic effects of methadone accumulation, was used in 24 patients requiring opioid therapy. After a priming period of three days with fixed doses of 3-5 mg three times a day for naive patients and 50% of the morphine equivalent of methadone in patients switched from morphine, patients and relatives were instructed to maintain the night-time dose and to administer a second dose when the pain recurred. When more than four doses of methadone a day were used, an increase of the dosage was prescribed. Continuous pain assessment and monitoring of symptoms were offered. RESULTS: The majority of patients achieved good pain relief until death, and three were switched to very low doses of subcutaneous morphine in their final days. The methadone escalation index was about 2% a day, with a mean dosage increase of 0.3 mg a day for an average of 60 days of treatment at doses ranging from 9 to 80 mg. The plasma concentration in 14 patients ranged from 0.013 to 0.273 mcg/ml with dosages of 20-80 mg during chronic treatment. A mean of 2.4 doses a day was reported, including the fixed night-time dose. The extent of side effects was considered acceptable. CONCLUSION: Patient-administered analgesia with oral methadone appears to be a simple, cheap and relatively safe technique for controlling cancer pain, permitting individualization by the patient him- or herself and avoiding the risk of accumulation. Continuous assessment is necessary.
1996
Mercadante S; Sapio M; Serretta R; Caligara M
Annals Of Oncology : Official Journal Of The European Society For Medical Oncology / Esmo
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/oxfordjournals.annonc.a010679" target="_blank" rel="noreferrer">10.1093/oxfordjournals.annonc.a010679</a>
Morphine and alternative opioids in cancer pain: the EAPC recommendations
Humans; Analgesics; Drug Administration Schedule; Administration; Oral; Palliative Care/standards; Injections; Intravenous; Subcutaneous; Oxycodone/administration & Pain/drug therapy; Opioid/administration & dosage/adverse effects/therapeutic use; Spinal; Chemistry; Fentanyl/administration & dosage/therapeutic use; Hydromorphone/administration & Infusions; Methadone/pharmacokinetics/therapeutic use; Morphine/administration & Neoplasms/drug therapy; Pharmaceutical
An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.
2001
Hanks GW; Conno F; Cherny NI; Hanna M; Kalso E; McQuay HJ; Mercadante S; Meynadier J; Poulain P; Ripamonti C; Radbruch L; Casas JR; Sawe J; Twycross RG; Ventafridda V; Expert Working Group of the Research Network of the European Association for Palliative Care
British Journal Of Cancer
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1054/bjoc.2001.1680" target="_blank" rel="noreferrer">10.1054/bjoc.2001.1680</a>
Methadone response in advanced cancer patients with pain followed at home
Female; Humans; Male; Pain; Pain Measurement; Analgesics; Prospective Studies; Middle Aged; Sex Factors; Neoplasms/physiopathology; Methadone/administration & dosage/adverse effects/therapeutic use; Opioid/administration & dosage/adverse effects/therapeutic use; home care services; Intractable/drug therapy
Concerns about the safety of therapy with methadone, which may arise because of its pharmacokinetic characteristics and inappropriate dosing, may deter clinicians from using this drug, especially in elderly patients. Experience is accumulating that the drug may be used safely and successfully if low doses are given initially and care is taken in the titration of the dose against the pain. A prospective study was carried out in a consecutive sample of 45 advanced cancer patients followed at home, who had never received other strong opioids for their pain. Patients were treated with an oral liquid preparation of methadone, which was administered 2-3 times daily, according to need. Doses were kept as low as possible and were titrated to achieve acceptable analgesia with minimal adverse effects. The methadone starting dose (MSD) at referral, the maximum dose of methadone (MMD), the days of methadone treatment, the use of other nonopioid analgesics, symptoms associated with methadone therapy, pain intensity, and pain mechanism were recorded. Methadone escalation index percentage (MEI%) and methadone escalation index in mg (MEI mg) were calculated from these parameters. No correlations between age and gender, and MSD, MMD, days on methadone, VAS and symptoms were found. No significant differences were found in pain mechanisms, age, and other parameters, including methadone-related symptoms. Treatment of pain with methadone provides important support to patients with cancer followed at home and the risks are low with individually titrated doses, even in older patients or in the presence of a neuropathic pain mechanism.
1999
Mercadante S; Casuccio A; Agnello A; Barresi L
Journal Of Pain And Symptom Management
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0885-3924(99)00048-2" target="_blank" rel="noreferrer">10.1016/s0885-3924(99)00048-2</a>
Barriers and Adherence to Pain Management in Advanced Cancer Patients
palliative care; barriers; cancer pain; opioids; adherence to medication
AIM: To assess patients' barriers to pain management and analgesic medication adherence in advanced cancer patients METHODS: Prospective cross-sectional study in advanced cancer patients receiving chronic opioid therapy. Age, gender, cancer diagnosis, Karnofsky level, and educational status were recorded. collected. These included age, gender, cancer diagnosis, Karnofsky level, and educational status. The Brief Pain Inventory (BPI), the Edmonton Symptom Assessment Scale (ESAS), the Memorial Delirium Assessment Scale (MDAS), the Barriers Questionnaire II (BQ-II), medication Adherence Rating Scale (MARS), and Hospital Anxiety and Depression Scale (HADS) were measured. RESULTS: One-hundred-thirteen patients were analyzed. The mean age was 68 (± 13) years and 59 (52%) were males. The mean Karnofsky status was 51.4 (SD 11.5). The mean value of BQ-II items was 1.77 (SD 0.7). BQ-II was independently related with HADS-D (p=0.033), and with total HADS (p=0.049). Negative side-effects and attitudes to psychotropic medication globally prevailed among MARS items. These items were independently associated with gender (P=0.030), pain (; p=0.003), and depression (p= 0.047). CONCLUSION: Barriers to pain management were mild. Psychological factors such as depression were the main factor associated with barriers. Poor adherence to analgesic medication was mostly manifested as negative side-effects and attitudes to psychotropic medication, was more frequent observed in females and was associated with ESAS items pain and depression.
Mercadante S; Adile C; Tirelli W; Ferrera P; Penco I; Casuccio A
Pain Practice
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/papr.12965" target="_blank" rel="noreferrer noopener">10.1111/papr.12965</a>