Improved Pain Control in Terminally Ill Cancer Patients by Introducing Low-Dose Oral Methadone in Addition to Ongoing Opioid Treatment

Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy.To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain.This was a retrospective chart review.All patients with advanced cancer treated in a specialized palliative care unit who had received oral methadone in addition to another regular opioid were identified.Intensity of pain, opioid doses, and occurrence of sedation, delirium, and respiratory depression were obtained from the patients' medical records for a period of one week after initiation of methadone.Eighty patients were included. The median daily methadone dose was 10 mg during the treatment period. Eighty percent of the patients had improved pain control (p < 0.001). There was an increased risk for sedation and delirium, most pronounced in patients living 14 days or less after the start of methadone. No patient experienced respiratory depression.Addition of low-dose oral methadone to regular high-dose opioid treatment in cancer patients with complex pain close to death improves pain control, but also increases the risk for sedation and delirium.