Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study
by
Bruera E, Palmer JL, Bosnjak S, Rico MA, Moyano J, Sweeney C,
Strasser F, Willey J, Bertolino M, Mathias C, Spruyt O, Fisch MJ.
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
J Clin Oncol. 2004 Jan 1; 22(1): 185-92
ABSTRACTPURPOSE: To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain. PATIENTS AND 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. CONCLUSION: 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.Pain
LAAM
Fentanyl
Tramadol
Tolerance
Remifentanil
Endomorphins
LAAM v methadone
Methadone: structure
Opioids and depression
Methadone and cocaine
Methadone maintenance
Rapid opioid detoxification
Methadone and cancer pain
Methadone: "killer drug" etc
Buprenorphine v methadone
Methadone, LAAM and the rush
Methadone for tramadol addicts?
Methadone/morphine as antidepressants
and further reading
Refs
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