Been having some terrific N=1 successes recently using adjuvant methadone in resistant neuropathic cancer pain.
This Canadian group lead by Dr Courtemanche in Quebec followed 150 ish patients with cancer neuropathic pain who had low dose methadone added as an adjunct. They found that half the patient responded, where response was defined as a greater than 30% decrease in pain intensity. Median time to response was 7 days. Formidable!
In the same issue of the Journal of Pain and Symptom Management, a Japanese team lead by Dr Sakamoto in Nagoya found that pain intensity was reduced in most of the 28 patients who were rotated to methadone from other opioids with neuropathic pain caused by cancer. Sugoi!
Methadone… do you love it? Hate it? Fear it?
Sugoi! I love it (and fear it but I think deservedly so – don’t want to get cocky when prescribing methadone). I haven’t prescribed it for a long time…Delirium Care Unit maybe not the best setting!?
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Yeah but no but yeah maybe not the best setting? A little bit of fear where methadone is concerned is definitely a good thing I reckon.
Thanks Sonia. I use adjuvant methadone quite a bit. I have actually found myself wondering over time whether this evidence has changed the frequency of rotation to methadone. I have noted that we often seem to try an adjuvant dose and step-up if required while decreasing other opioids rather than formally rotating. Anyone else have any similar experiences?
Yes, me, I do exactly that as the thought of doing a full rotation to methadone over a couple of days can seem a bit scary. There’s a formal protocol at work which i really do not like at all; it might be fine pharmacologically but there is no way the nurses follow it; they often give the wrong breakthrough. I think it’s just too complicated to use.
I have tried two different protocols for conversion and both went badly. I use the Fullerton (!) method of adding 5mg nocte and had a lot of success. Sometimes need to increase the dose, but often not.
Hi. Sonia．Thank you for invitation to blog, that’s very nice．I’m a methadone lover, too, and glad to meet you.
In our manuscript we would tell that methadone
have the power to save other analgesics, to save the other opioids, and to save money.
We recommends the method of safety opioids rotation, also we felt, underwent partial rotation and opioids combination.
That’s very safty except for several situationーmultiple drug interaction, antifungal agent or chemotherapyー.