Abstract
Compared with nociceptive pain, neuropathic pain is a challenging diagnosis to make and successfully treat in children with cancer. The objective of this case report was to see whether very-low-dose methadone (VLDM) (defined as <50% of accepted starting analgesic dose of methadone for children) would be an effective strategy to treat refractory neuropathic pain due to vincristine in two children with acute lymphoblastic leukemia. This case report is based on the clinical experience and parent-reported outcomes of two children with refractory neuropathic pain who received VLDM. Based on parent/caregiver-reported outcome scores over a one-year period, both children's refractory neuropathic pain syndrome was successfully treated with the addition of VLDM to their pre-existing regimen of gabapentin. Neither child suffered any adverse effects from methadone. VLDM shows promise as an effective, safe, and inexpensive way to treat refractory neuropathic pain in children with cancer.
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