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Methadone and palliative care

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...
October 11, 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, multicentre 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 endpoint 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 2 consecutive days) and no overdose (Rudkin scale ≥3 and respiratory rate <8/min)...
September 29, 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...
July 12, 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
Neil Hilliard, Stuart Brown, Steve Mitchinson
BACKGROUND: This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. CASE PRESENTATION: A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil...
March 2015: Palliative Medicine
Brittany Burns Dennis, Leen Naji, Monica Bawor, Ashley Bonner, Michael Varenbut, Jeff Daiter, Carolyn Plater, Guillaume Pare, David C Marsh, Andrew Worster, Dipika Desai, Zainab Samaan, Lehana Thabane
BACKGROUND: Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone...
2014: Systematic Reviews
Donna Spaner
BACKGROUND: Methadone is a useful analgesic for neuropathic and nociceptive pain. However, there is little information about the use of methadone in the final days of life when a patient cannot swallow, discouraging its use by many palliative care physicians. OBJECTIVE: The purpose of this study was to investigate the effectiveness of switching patients on oral methadone at the end of life to methadone by the buccal mucosa route. METHODS: This is a case series comprising 36 patients on the Toronto Grace Palliative Care Unit (PCU) who took methadone between 2010 and 2012...
November 2014: Journal of Palliative Medicine
Nick Doukas
Today's methadone patients differ greatly from those of the past. Because of the rise of polydrug use and the HIV and hepatitis epidemics, treatment has become much more complex, which multiply the concerns and complexities of treatment. Patients entering methadone programs are also more commonly presenting at ages well into their 50s, 60s, and 70s; and this phenomenon of high rates continues to grow. The majority of these individuals in treatment have presented with a number of significant comorbid medical conditions that will progress and eventually lead to death...
2014: Journal of Social Work in End-of-life & Palliative Care
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