Abstract
Methadone has been known since the beginning of the 20th century. Its use for cancer pain is still controverted. Several articles clearly show the benefit of methadone for cancer pain. We attempted to identify the advantages of use of methadone early on in the course of cancer. Methadone is a very interesting molecule for cancer pain treatment because of anti NMDA, SSRI and opioid actions, lack of active metabolite, and cost. Its benefits must be balanced against the potential drug to drug interactions during treatment initiation and interactions with other drugs when methadone doses are stable. As for all opioids, side effects can appear. Ten studies including 706 patients support the use of methadone as first line opioid treatment: 7 are prospective studies (one double-blind randomized with morphine, 4 randomized controlled with morphine or transdermal fentanyl, two open studies) and 3 are retrospective studies. Seven studies support its ambulatory initiation (3 prospective including 2 controlled studies, and 4 retrospective studies) with a total of 845 patients. Methadone could be used with caution early on in cancer pain management.
Highlights
In the early 30s, methadone was discovered by Bockmuhl and Ehrhart at J
Methadone’s half-life varies greatly from one patient to another [3]. This particularity leads to a specific use, for example switching to methadone is governed by different rules than when switching to other opioids
Methadone acts as an N Methyl D Aspartate (NMDA) antagonist, which limits opioid hyperalgesia and tolerance phenomena
Summary
In the early 30s, methadone was discovered by Bockmuhl and Ehrhart at J. We attempt to present why methadone might be preferred to other opioids in cancer pain. Methadone’s half-life varies greatly from one patient to another [3] This particularity leads to a specific use, for example switching to methadone is governed by different rules than when switching to other opioids. Methadone acts as an N Methyl D Aspartate (NMDA) antagonist, which limits opioid hyperalgesia and tolerance phenomena. Selective Serotonin Recapture Inhibition is induced by methadone, limiting chronic pain development. Methadone seems to be unique analgesic for nociceptive pain and may be effective for cancer pain because pain is often mixed: nociceptive and neuropathic. All proposals are safe and efficient for pain relief [7,8,9,10,11,12,13,14]
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