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Methadone and palliative care

Wasek Faisal, Judith Jacques
Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting...
January 2017: Indian Journal of Palliative Care
Katherine M Juba, Tina M Khadem, David J Hutchinson, Jack E Brown
BACKGROUND: Methadone (ME) is commonly used in pain and palliative care (PPC) patients with refractory pain or intolerable opioid adverse effects (AEs). A unique ME AE is its corrected QT (QTc) interval prolongation risk, but most evidence exists in methadone maintenance therapy patients. OBJECTIVE: Our goal was to identify QTc interval prolongation risk factors in PPC patients receiving ME and other medications known to prolong the QTc interval and develop a risk stratification tool...
February 10, 2017: Journal of Palliative Medicine
Marie Pierre Berleur, Shimsi Lefki, Daniele Lefebvre Kunt, Eric Serra, Gisele Chvetzoff, Alain Derniaux, Flora Tremellat, Marilène Filbet, Anna Simon, Bich Dang Vu, Cyril Guillaume
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. METHODS: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Jennifer Hudson, Rachel Mayo, Lori Dickes, Liwei Chen, Windsor Westbrook Sherrill, Julie Summey, Bradley Dalton, Kindal Dankovich
Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted...
May 2017: American Journal of Perinatology
Tammy Vu Bach, Jonathan Pan, Anne Kirstein, Cindy Joanne Grief, Daphna Grossman
Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally...
December 2016: Journal of Palliative Medicine
Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, Marilène Filbet
CONTEXT: In the European Association for Palliative Care recommendations for cancer pain management, there was no consensus regarding the indications, titration, or monitoring of methadone. OBJECTIVES: This national, randomized, multicenter trial aimed to compare two methadone titration methods (stop-and-go vs. progressive) in patients with cancer-related pain who were inadequately relieved by or intolerant to Level 3 opioids. METHODS: The primary end point was the rate of success/failure at Day 4, defined as pain relief (reduction of at least two points on the visual scale and a pain score <5 for two consecutive days) and no overdose (Rudkin scale ≥3 and respiratory rate <8/minute)...
November 2016: Journal of Pain and Symptom Management
Mel Clark Taveros, Elizabeth J Chuang
CONTEXT: Prescription opioid and heroin abuse has increased substantially in recent years. Enrolment on opioid agonist therapy programmes is consequently increasing as well. As a result of these trends, more patients who present with acute pain secondary to a malignancy are also on chronic methadone maintenance therapy (MMT) for substance abuse. This combination of diagnoses presents a pain management challenge for palliative care providers. OBJECTIVES: This paper aims to gather and review the available medical literature pertaining to the use of opioid analgesia in methadone-maintained patients...
August 26, 2016: BMJ Supportive & Palliative Care
Tanja Fusi-Schmidhauser, Donata Bardelli
The numb chin syndrome is a rare manifestation of intractable pain in the palliative care setting and represents a major therapeutic challenge. The reported etiologies of the numb chin syndrome include trauma, infections, immune-mediated systemic conditions, and malignancy, both through local infiltration or compression of the inferior alveolar nerve sheath. The authors present the case of a patient with long-standing multiple myeloma, suffering from numb chin syndrome caused by a spontaneous osteonecrosis of the jaw after bisphosphonate therapy...
September 2016: Journal of Pain & Palliative Care Pharmacotherapy
Yosuke Sugiyama, Nobuhiro Sakamoto, Masahiro Ohsawa, Mami Onizuka, Kyoko Ishida, Yuki Murata, Ayaka Iio, Koji Sugano, Ken Maeno, Hiromitsu Takeyama, Tatsuo Akechi, Kazunori Kimura
BACKGROUND: Cancer-related neuropathic pain is resistant to treatment with multiple medications and results in reduced patient quality of life. OBJECTIVE: The aim was to find a new curative to treat neuropathic pain without using adjuvant analgesics. DESIGN: This was a retrospective study that used the FACES Pain Scale (FPS) to measure pain intensity and pain relief. SETTING/SUBJECTS: Twenty-eight inpatients who were treated with other strong opioids and who consulted the palliative care team about their pain relief...
October 2016: Journal of Palliative Medicine
Fanny Courtemanche, Denis Dao, Félixe Gagné, Lydjie Tremblay, Andrée Néron
BACKGROUND: Methadone offers many advantages for treating cancer pain. However, its pharmacokinetic profile makes its use as a full-dose opioid challenging. OBJECTIVES: To evaluate the efficacy and safety of low-dose methadone as an adjunct to opioids in the treatment of cancer pain in palliative care patients. DESIGN: A cohort was followed retrospectively for up to 60 days after the initiation of methadone as a coanalgesic. SETTING/SUBJECTS: Patients were eligible if they were prescribed methadone as a coanalgesic for cancer pain management and followed by the palliative care team...
September 2016: Journal of Palliative Medicine
Josep Porta-Sales, Cristina Garzón-Rodríguez, Christian Villavicencio-Chávez, Silvia Llorens-Torromé, Jesús González-Barboteo
INTRODUCTION: Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic. PATIENTS AND METHODS: This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone...
August 2016: Oncologist
Gabriela P Peirano, Guillermo P Mammana, Mariela S Bertolino, Tania Pastrana, Gloria F Vega, Jorgelina Russo, Gabriela Varela, Ernesto Vignaroli, Raúl Ruggiero, Arnaldo Armesto, Gabriela Camerano, Graciela Dran
PURPOSE: The use of methadone for cancer pain is limited by the need of expertise and close titration due to variable half-life. Yet, it is a helpful palliative strategy in low-resources countries given its long-acting effect at low cost and worth additional study. Our aim was to describe the prescription and outcomes of methadone as a first-line treatment for cancer pain in a tertiary palliative care unit (PCU) in Argentina. METHODS: Retrospective review of medical records of patients with moderate to severe cancer pain seen at the PCU in 1-year period, who initiated strong opioids at the first consultation...
August 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Snezana M Bosnjak, Martha A Maurer, Karen M Ryan, Ivana Popovic, S Asra Husain, James F Cleary, Willem Scholten
Cancer is the second leading cause of death in Serbia, and at least 14,000-16,000 patients experience moderate-to-severe cancer pain every year. Cancer pain relief has been impeded by inadequate availability of opioid analgesics and barriers to their accessibility. In 2006, a Serbian oncologist was selected as an International Pain Policy Fellow. The fellow identified barriers to opioid availability in Serbia and implemented an action plan to address the unavailability of oral morphine, attitudinal and knowledge barriers about opioids, and barriers in the national opioid control policy, in collaboration with the government, local partners, and international experts, including those from the World Health Organization...
August 2016: Journal of Pain and Symptom Management
Deborah Dowell, Tamara M Haegerich, Roger Chou
IMPORTANCE: Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE: To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS: The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs...
April 19, 2016: JAMA: the Journal of the American Medical Association
Matthew T Mendlik, Tanya J Uritsky
Neuropathic pain is notoriously variable in its severity and impact on patients, as well as in its response to treatment. Certain therapies for neuropathic pain have better evidence for their use; however, it is apparent that although some therapies provide relief for only a minority of patients, the relief may be significant. Without a trial of therapy, there is no way to know if that relief is achievable. Our treatment experiences have shown that occasionally unexpected benefit is obtained through a thorough investigation of all options, even in the setting of failure of those with the most compelling evidence or indication...
December 2015: Current Treatment Options in Neurology
Thien C Pham, Jeffrey Fudin, Robert B Raffa
BACKGROUND: Methadone has been a stalwart pharmacologic option for the management of opioid drug dependence for many years. It substitutes for opioid agonists and possesses certain pharmacokinetic properties that confer characteristics preferable to those of other opioids for this application. Methadone is likewise used as an option for the treatment of pain, particularly chronic pain. It has a spectrum of pharmacodynamic activity, including contributions from non-opioid components, that translates to its specific clinical attributes as an analgesic...
September 2015: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
K Eckart, J Röhrich, D Breitmeier, M Ferner, R Laufenberg-Feldmann, R Urban
A liquid chromatography-tandem mass spectrometry method using electrospray ionization in positive ionization mode was developed for the simultaneous detection of multiple opioid-type drugs in plasma. The presented assay allows the quantitative determination of alfentanil, buprenorphine, codeine, desomorphine, dextromethorphan, dextrorphan, dihydrocodeine, dihydromorphine, ethylmorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, naloxone, naltrexone, oxycodone, oxymorphone, pentazocine, pethidine, pholcodine, piritramide, remifentanil, sufentanil, and tramadol as well as the metabolites 6-monoacetylmorphine, bisnortilidine, morphine-3-glucuronide, morphine-6-glucuronide, naltrexol, norbuprenorphine, norfentanyl, norpethidine, nortilidine, and O-desmethyltramadol...
September 15, 2015: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Enrique J Cobos, José M Baeyens
No abstract text is available yet for this article.
August 2015: Journal of Palliative Medicine
Somayeh Khalesi, Hassan Shemirani, Faezeh Dehghani-Tafti
BACKGROUND: Methadone is a synthetic opioid, which has been successfully used in treating heroin addiction and chronic pain syndrome in palliative care for more than 30 years. This drug is a potent blocker of the delayed rectifier potassium ion channel, which may result in corrected QT (QTc) interval prolongation and increased risk of torsades de pointes (TdP) in susceptible individuals. CASE REPORT: We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation, which was resolved after treatment with IV magnesium, potassium, and Lidocaine...
November 2014: ARYA Atherosclerosis
Shelley R Salpeter, Jacob S Buckley, Nicholas S Buckley, Eduardo Bruera
OBJECTIVE: Our aim was to evaluate the use of very-low-dose methadone with haloperidol in the acute-care setting. METHODS: We reviewed the records of 735 hospitalized patients receiving a palliative care consultation between 2011 and 2014. All patients with pain on opiates were offered conversion to methadone, 2.5 mg/day to 15 mg/day, in conjunction with scheduled haloperidol. Additional doses of haloperidol or short-acting opiates were given as needed for pain...
February 2015: Journal of Palliative Medicine
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