Opioid Analgesics Research Articles

Challenges in the treatment of opioid dependence

The number of persons using opioids has increased worldwide in the last decade, particularly the use of opioid analgesics in North America and Africa. In Germany, the prevalence of heroin addiction has remained relatively stable. Narrative review of the literature. Opioid-assisted maintenance treatment (OMT) with the established substances methadone, levomethadone, slow-release morphine and buprenorphine is recommended as the first-line treatment for heroin dependence. The OMT reduces the use of heroin, mortality and individual suffering and improves the quality of life and physical health. A diamorphine and heroine-assisted treatment is an option for people who do not benefit from conventional OMT. An alternative to the use of diamorphine could be treatment with hydromorphone hydrochloride. The regulations on carrying out maintenance treatment in the Controlled Substances Prescription Act and the guidelines of the Federal Medical Association in Germany have been loosened based on the experiences of the COVID-19 pandemic, for example with respect to take-home prescriptions. There is an ongoing intensive discussion on how to deal with the decreasing number of outpatient clinics offering OMT. The first-line treatment for opioid addiction is opioid-assisted substitution treatment, including diamorphine and heroin-assisted treatment. Long-acting depot medications and implants still play asubordinate role.

W144 - Association of Opioid Analgesics, Benzodiazepines, Gabapentinoids, and Opioid Agonist Treatment With Mortality Among Individuals With Opioid Dependence

W144 - Association of Opioid Analgesics, Benzodiazepines, Gabapentinoids, and Opioid Agonist Treatment With Mortality Among Individuals With Opioid Dependence

T51 - Evaluating Changes in Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder Before and During the COVID-19 Pandemic

T51 - Evaluating Changes in Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder Before and During the COVID-19 Pandemic

Opioid-induced neuroanatomical, microglial and behavioral changes are blocked by suvorexant without diminishing opioid analgesia

Opioid-induced neuroanatomical, microglial and behavioral changes are blocked by suvorexant without diminishing opioid analgesia

Attentional Bias for Opioids in Taiwanese Heavy Smokers with Chronic Noncancer Pain.

Background and Objectives: Attentional bias (AB) for addictive substances is a feature of attention found in individuals with substance misuse or diagnosed with substance use disorders. When AB exists, the attention of the addicted individual may be quickly oriented to cues related to the addictive substance or be maintained on these cues for a longer time. AB toward opioids was found in Western samples of smokers with chronic noncancer pain. The level of AB was dose-responsive. However, similar studies in the Taiwanese population are lacking. This study compared the patterns of AB for opioid analgesics in Taiwanese participants with chronic noncancer pain to that of individuals without pain. This study aimed to investigate if AB toward opioids is presented in Taiwanese heavy smokers who are on long-term opioid therapy for pain control. Materials and Methods: Participants were grouped into chronic noncancer pain smokers, chronic pain nonsmokers, and smokers without pain, according to smoking habits and whether or not on long-term opioid therapy for pain control. Each participant completed demographic questionnaires, mood scales, and the opioid-related visual probe task. Differences in AB among the groups were compared using a three-way analysis of covariance controlling for daily cigarette consumption. Results: Chronic noncancer pain smokers (n = 17) and chronic pain nonsmokers (n = 16) displayed more severe levels of depression, anxiety, and pain, compared to smokers without pain (n = 28). Only did chronic pain nonsmokers show significant AB for opioid cues that were displayed for a short time. Analysis on reaction time found that smokers without pain consistently responded faster to the tasks. No difference in reaction time was found between the pain groups. Conclusions: The current study did not fully replicate findings from studies that were based in Western countries. Formulary availability and regulatory limitations might have affected patient's perception of prescription opioids in Taiwan. However, chronic pain nonsmokers exhibited initial orientation toward opioid-related cues when daily cigarette consumption was accounted for. According to previous research, this AB for shortly displayed opioid cues can be associated with the expectation of pain relief. The current finding also indicated general psychomotor retardation in individuals who were on long-term use of opioids.

Efficacy and Safety of Intrathecal Morphine for Cesarean Delivery: A Narrative Review.

Pain management is a critical aspect of care during and following a cesarean delivery. Without proper control of pain, individuals can experience poor mobility, increased thromboembolic events, and difficulty caring for the neonate in the postpartum period. There have been multiple methods for pain management for cesarean delivery and intrathecal morphine (ITM) has emerged as a prominent option for post-operative analgesia due to its efficacy, safety, and potential benefits over other treatments. This review analyzes data on efficacy, side effects, and safety of ITM and the pain control alternatives. A comprehensive literature review was conducted to compare ITM with other analgesic techniques in post-cesarean patients. ITM was found to be as effective or better than other analgesic options, including bilateral quadratus lumborum block (QLB), opioid-free epidural analgesia (CSEA-EDA), and intravenous fentanyl. One study found that both ITM and oral analgesia were effective in pain control and that ITM caused fewer breakthrough pain events but had a longer duration and a greater rate of side effects than oral opioid analgesia. Commonly observed side effects of intrathecal opioids include nausea, vomiting, pruritus, and urinary retention, and it is thought that the adverse effects from intrathecal administration of opioids are short-lived. ITM may provide a decreased risk of DVT and coagulation by decreasing lower extremity weakness and numbness, thereby decreasing recovery time and increasing mobility. ITM is a safe and effective option for post-cesarean analgesia, with comparable pain relief to alternative forms of pain control, and side effects that are generally manageable. Further research is warranted to explore beneficial combinations with other methods of pain management and optimal dosing strategies.

Δ9-Tetrahydrocannabinol Alleviates Hyperalgesia in a Humanized Mouse Model of Sickle Cell Disease.

People with sickle cell disease (SCD) often experience chronic pain as well as unpredictable episodes of acute pain, which significantly affects their quality of life and life expectancy. Current treatment strategies for SCD-associated pain primarily rely on opioid analgesics, which have limited efficacy and cause serious adverse effects. Cannabis has emerged as a potential alternative, yet its efficacy remains uncertain. In this study, we investigated the antinociceptive effects of Δ9-tetrahydrocannabinol (THC), cannabis' intoxicating constituent, in male HbSS mice, which express >99% human sickle hemoglobin, and male HbAA mice, which express normal human hemoglobin A, as a control. Acute THC administration (0.1-3 mg/kg-1, i.p.) dose-dependently reduced mechanical and cold hypersensitivity in human sickle hemoglobin (HbSS) but not human normal hemoglobin A (HbAA) mice. In the tail-flick assay, THC (1 and 3 mg/kg-1, i.p.) produced substantial antinociceptive effects in HbSS mice. By contrast, THC (1 mg/kg-1, i.p.) did not alter anxiety-like behavior (elevated plus maze) or long-term memory (24-hour novel object recognition). Subchronic THC treatment (1 and 3 mg/kg-1, i.p.) provided sustained relief of mechanical hypersensitivity but led to tolerance in cold hypersensitivity in HbSS mice. Together, the findings identify THC as a possible therapeutic option for the management of chronic pain in SCD. Further research is warranted to elucidate its mechanism of action and possible interaction with other cannabis constituents. SIGNIFICANCE STATEMENT: The study explores Δ9-tetrahydrocannabinol (THC)'s efficacy in alleviating pain in sickle cell disease (SCD) using a humanized mouse model. Findings indicate that acute THC administration reduces mechanical and cold hypersensitivity in SCD mice without impacting emotional and cognitive dysfunction. Subchronic THC treatment offers sustained relief of mechanical hypersensitivity but leads to cold hypersensitivity tolerance. These results offer insights into THC's potential as an alternative pain management option in SCD, highlighting both its benefits and limitations.

Utilization and Evaluation of Analgesics in Post Gynecologic Operations: A Cross- Sectional Study

Background: This study evaluated the current practices of opioid and non-opioid analgesic administration for postoperative pain management in gynecological surgeries, aiming to optimize pain relief while minimizing side effects. Methods: A cross-sectional, prospective Drug Utilization Evaluation (DUE) study was conducted at Al-Zahra Hospital, Tabriz, Iran. Medical records of 100 patients undergoing gynecological surgery were reviewed over five months. Data on prescribed analgesics, pain scores, and adherence to APS2016 and ERAS2016 guidelines were collected and analyzed statistically. Results: Meperidine (pethidine) and diclofenac were the most frequently prescribed analgesics. The average patient pain score was 2.48 units. A combination of meperidine, diclofenac, and acetaminophen was identified as the most effective regimen for pain control. Prescribed regimens demonstrated 41.4±27.3% theoretical and 60.60 ± 28.77% practical compliance with APS2016 and ERAS2016 guidelines. While achieving the primary objective of pain relief with minimal side effects, compliance with established guidelines could be further improved through educational interventions. Conclusion: Optimizing analgesic regimens for postoperative pain management requires careful consideration of individual patient needs, including the benefits of opioid analgesics in achieving greater pain reduction. Adherence to evidence-based guidelines and ongoing educational programs for healthcare professionals are crucial for ensuring optimal pain relief with minimal side effects.

Opioid and non-opioid analgesic regimens after fracture and risk of serious opioid-related events

BackgroundNon-opioid analgesics are prescribed in combination with opioids among patients with long bone fracture to reduce opioid prescribing needs, yet evidence is limited on whether they reduce the risk of...

Promoting Safer Opioid Practices and Professional Collaboration Through Interprofessional Simulation.

Simulation-enhanced interprofessional education is widely viewed as an effective teaching pedagogy to foster effective communication and teamwork for healthcare students. Pharmacists and registered nurses must learn to work collaboratively during their educational programs in order to be prepared for the complexities of modern healthcare. This study evaluated prelicensure pharmacy and prelicensure nursing students' perceptions of professional collaboration before and after caring for a standardized patient exhibiting opioid dependence secondary to inappropriate use of an opioid analgesic. Statistically significant gains in communication, collaboration, roles and responsibilities, patient-centered care, conflict management, and team functioning were measured for both pharmacy and nursing students after the interprofessional simulation. This study adds to the existing evidence that suggests simulation-enhanced interprofessional education is an effective teaching strategy; however, this study demonstrates its usefulness for students learning about safer opioid analgesic practices.

Comparison between Combination of Proximal Adductor Canal Block and Infiltration between Popliteal Artery and Capsule of Knee (iPACK) with Large-Volume Distal Adductor Canal Block in Facilitating Early Mobilization after Total Knee Replacement: A Randomized, Single-Blind Study

Abstract Background: Adductor canal block (ACB) and infiltration between popliteal artery and capsule of knee (iPACK) are popular block methods for analgesia after total knee replacement (TKR), covering both the anterior and posterior knee. This study aimed to compare the performance of the combination of ACB and iPACK with large-volume distal ACB in facilitating early mobilization after TKR. Patients and Methods: This study was a single-blind, randomized, controlled trial of 30 subjects who underwent TKR. Subjects were randomly assigned to either Group A (the large-volume distal ACB) or Group B (the combination of proximal ACB and iPACK). Outcome variables included postoperative time up and go (TUG) test, numeric rating scale (NRS), postoperative morphine consumption, block-performing time, time to first opioid rescue analgesia, and side effects. Results: This study found that the block-performing time was significantly shorter in Group A compared to Group B (230.67 vs. 509.67, P < 0.001). The mean postoperative TUG test (67 vs. 64, P = 0.78), NRS at all-time points, and postoperative morphine consumption (3 vs. 3 mg, P = 0.85) did not differ significantly. No block-related side effects were found in either group. Conclusion: Large-volume distal ACB is not superior to the combination of proximal ACB and iPACK in facilitating early mobilization after TKR. Block-performing time of distal ACB was shorter compared to the combination of proximal ACB and iPACK.

Oral transmucosal fentanyl citrate as breakthrough pain relieving medication: A pilot study

ABSTRACT Background: Breakthrough pain in cancer patients is a common and distressing symptom that significantly impacts their quality of life. Traditional pain management strategies often fail to provide adequate relief. Oral transmucosal fentanyl citrate (OTFC) has emerged as a rapid-onset opioid analgesic, offering a potential solution for managing this challenging condition in home care settings. Aims: This study aims to evaluate the efficacy of OTFC in managing breakthrough pain and its effects on the quality of life in cancer patients treated at home. Materials and Methods: A pilot study was conducted with 40 cancer patients experiencing more than one episode of breakthrough pain daily. These patients were administered OTFC 400 μg for pain management. Degree of pain (NRS) and modified ‘Quality of Well-being’ (QWB) scores were analysed using data filled in by patients. Data were collected and analysed using paired t-tests to compare pre- and post-treatment scores. Results: The administration of OTFC resulted in a significant reduction in pain, as indicated by the decrease in NRS scores from 9.9 ± 0.304 to 0.5 ± 0.906 within 30 minutes (P < 0.0001). Additionally, there was a marked improvement in QWB scores, which increased from 26.18 ± 2.8 to 36.3 ± 3.16 over the same period (P < 0.001). Mild side effects, such as nausea, headache, and somnolence, were reported, but no serious adverse events were observed. Conclusions: We conclude that OTFC 400 μg is an effective and well-tolerated option for managing breakthrough pain in cancer patients and in improving the quality of life in home care settings.

Early Opioid Use and Postoperative Delirium Following Open Abdominal Aortic Aneurysm Repair

Postoperative delirium is a common complication following open abdominal aortic aneurysm repair (OAR). Opioids have been found to contribute to delirium, especially at higher doses. This study assessed the impact of early postoperative opioid analgesia on postoperative delirium incidence and time to onset. We hypothesized that higher early postoperative opioid utilization would be associated with increased postoperative delirium incidence. This was a retrospective analysis of OAR cases at a single quaternary care center from years 2012-2020. The primary exposure was oral morphine equivalents use (OME), calculated for postoperative days 1-7. A cut point analysis using a receiver operator curve for postoperative delirium determined the threshold for high OME (OME>37mg). The primary outcome was postoperative delirium incidence identified via chart review. Multivariable logistic regression was performed for postoperative delirium and adjusted for covariates meeting P<0.1 on bivariate analysis. Among 194 OAR cases, 67 (35%) developed postoperative delirium with median time to onset of 3days (IQR=2-6). Patients with postoperative delirium were older (74years vs. 69years), more frequently presented with symptomatic AAA (47% vs. 27%) and had a higher proportion of comorbidities (all P<0.05). Cases with high OME utilization on postoperative day 1 (55%) were younger (69 vs. 73years), less frequently had an epidural (46% vs. 77%), and more frequently developed delirium (42% vs. 25%, all P<0.05). Epidural use was associated with a significant decrease in OME utilization on postoperative day 1 (33 vs. 83, P<0.01). Postoperative delirium onset was later in those with high OME use (4 vs. 2days, P=0.04). On multivariable analysis, high OME remained associated with postoperative delirium (Table II). High opioid utilization on postoperative day 1 is associated with increased postoperative delirium and epidural along with acetaminophen use reduced opioid utilization. Future study should examine the impact of opioid reduction strategies on outcomes after major vascular surgery.

Assessing Pain and Functional Outcomes of Percutaneous Stabilization of Metastatic Pelvic Lesions via Photodynamic Nails: A Bi-Institutional Investigation of Orthopaedic Outcomes.

Minimally invasive surgical interventions for metastatic invasion of the pelvis have become more prevalent and varied. Our group hypothesized that the use of percutaneous photodynamic nails (PDNs) would result in decreased pain, improved functional outcomes and level of ambulation, and decreased use of opioid pain medication. We performed a retrospective chart review of patients with metastatic pelvic bone disease undergoing stabilization with PDNs (IlluminOss Medical) at 2 institutions. Functional outcome measures assessed include the Combined Pain and Ambulatory Function (CPAF), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, and PROMIS Global Health-Physical. Pain was assessed using a visual analog scale (VAS). Outcomes were assessed preoperatively and at 6 weeks, 3 months, 6 months, and 1 year following surgery. A total of 39 patients treated with PDNs were included. No cases of surgical site infection or implant failure were identified. The median pain VAS score decreased from 8 preoperatively to 0 at the 6-week time point (p < 0.0001). The median CPAF score improved from 5.5 points preoperatively to 7 points at the 3-month mark (p = 0.0132). A significant improvement in physical function was seen at 6 months in the PROMIS Physical Function (p = 0.02) and at both 6 months (p = 0.01) and 1 year (p < 0.01) for the PROMIS Global Health-Physical. The rate of patients prescribed opioid analgesia dropped from 100% preoperatively to 20% at 6 months following surgery (p < 0.001). By 6 weeks, all patients were fully weight-bearing and able to walk independently with or without assistive devices. Percutaneous stabilization of metastatic periacetabular defects using PDNs is a safe and effective palliative procedure that has been shown to improve patient mobility and provide early pain relief. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Synthesis and pharmacological activity of various organic and inorganic salts of phenyl derivatives of imidazobenzimidazole

Introduction: The creation of new opioid analgesics that are devoid of the main undesirable effects – euphoria, respiratory depression, tolerance – is an important task for the treatment of pain syndrome. Eighteen salts of 9-pyrrolidinoethyl-(1a), 9-piperidinoethyl-(1b), and 9-morpholinoethyl-2-(4-fluorophenyl)benzo[d]imidazo[1,2-a]imidazole (1c) were synthesized and tested for kappa agonist and analgesic activity. Materials and Methods: Specific analgesic activity studies were conducted using models of nociceptive pain in the “Hot/Cold-plate” and ”Plantar Test” tests, and in neuropathic pain against the background of sciatic nerve ligation. The relationship between the physicochemical and pharmacological properties of the compounds was studied in silico using quantum chemistry methods and artificial neural network technology. Results: The most active compound identified was 4-(2-(2-(4-fluorophenyl)-benzo[d]imidazo[1,2-a]imidazol-9-yl)ethyl)morpholine dihydrochloride (1c.2HCl). EC50, acute toxicity, and conditional therapeutic index values were calculated, which were 38.8 times superior to the kappa agonist U50488. It was established that compound 1c.2HCl exhibits a dose-dependent analgesic effect in the “Hot/Cold-plate” test, which is six times superior to that of butorphanol, maintaining a statistically significant effect for six hours in the “Plantar test” and without causing the formation of tolerance with a ten-day administration. In models of neuropathic pain syndrome, 1c.2HCl with a fourteen-day administration significantly reduced tactile and cold allodynia by three and 1.6 times, respectively, and was not inferior in activity to gabapentin. The kappa-opioidergic mechanism of the antinociceptive action of 1c.2HCl compound was confirmed. Quantum chemistry methods and artificial neural network technologies have shown that the high level of kappa-opioid agonist activity of hydrochlorides, in contrast to other salts, results in lower total energy production; therefore, there is a significant increase in energy during the formation of a salt supramolecular complex. Conclusion: The most active compound was identified – 1c.2HCl, for which kappa-opioid activity in vitro and analgesic properties were revealed in various in vivo models. It has been shown that the compound does not cause the formation of tolerance and is not toxic.

Patient Satisfaction with Nonopioid Postoperative Analgesia in Head and Neck Surgery: A Prospective Randomized Trial.

To evaluate patients' satisfaction with opioid versus opioid-sparing postoperative analgesia in patients undergoing outpatient head and neck surgery. Prospective randomized trial. Tertiary care academic hospital. Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3analgesic regimens. First- and second-line medications were the following by group (1) Hydrocodone-acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone-acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction. One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0-10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3groups. In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid-sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient's perception of care.

Impact of opioid analgesics on survival in cancer patients receiving immune checkpoint inhibitors

PurposeThis study aimed to assess the effects of concurrent opioid analgesic (OA) use with immune checkpoint inhibitors (ICIs) on progression-free survival (PFS) and overall survival (OS).MethodsIn this observational retrospective study, we included advanced cancer patients who received ICIs at Hacettepe University Hospital’s Department of Medical Oncology between June 2018 and January 2023.ResultsOur study included 375 recurrent or metastatic cancer patients treated with ICIs in the first, second line, or beyond. There were no significant differences between the OA-treated and OA-untreated groups regarding median age, age group, gender, primary tumor location, ICI type, or the presence of baseline liver and lung metastases. However, the OA-treated group exhibited a significantly higher proportion of patients who had received three or more prior treatments before initiating ICIs (p = 0.015). OA-Untreatment was significantly correlated with prolonged mPFS (6.83 vs. 4.30 months, HR 0.59, 95% CI 0.44–0.79, p < 0.001) and mOS (17.05 vs. 7.68 months, HR 0.60, 95% CI 0.45–0.80, p < 0.001).ConclusionsOur study demonstrates an association between the concurrent use of OAs and reduced OS and PFS in patients treated with ICIs. While OA treatment serves as a surrogate marker for higher disease burden, it may also suggest a potential biological relationship between opioids and immunotherapy efficacy.

The performance of a post-induction fentanyl-test in predicting postoperative respiratory adverse events in children after adenotonsillectomy.

Postoperative respiratory adverse events (PRAE) occurred more frequently in children having adenotonsillectomy than the general surgical population, and can require escalation of care. This study aims to assess the usefulness of post-induction fentanyl-test to predict PRAE in children with obstructive sleep apnea (OSA) after adenotonsillectomy. Two hundred and forty patients with OSA undergoing adenotonsillectomy were included in this study. The oxygen saturation during sleep was monitored the night before adenotonsillectomy. Fentanyl-test was conducted under spontaneous breath after anesthesia induction with sevoflurane. Fentanyl-induced reduction in respiratory rate (FRR) was defined as the percentage of reduction in respiratory rate after 1 mcg/kg fentanyl administration. PRAE in the post-anesthesia care unit (PACU) included both respiratory complications and medical interventions. Receiver operating characteristic (ROC) analysis was used to assess the usefulness of fentanyl-test in predicting PRAE. Of the 240 children undergoing elective adenotonsillectomy, 38 children (16%) experienced PRAE in PACU. The areas under ROC curve for FRR and Nadir SpO2 were 0.756 and 0.692, respectively. FRR greater than 53% best predicted PRAE in PACU, with a sensitivity of 68% and a specificity of 72%. Patients with FRR > 53% exhibited a significantly longer duration of desaturation requiring supplementary oxygen than those with FRR ≦ 53% (p < 0.001). We suggest that post-induction fentanyl-test is a feasible evaluation for children undergoing adenotonsillectomy to predict early PRAE, especially for those who have not undergone polysomnography. Registry: ClinicalTrials.gov; Name: Effects of Individualized Opioid Analgesia Versus Conventional Opioid Analgesia After Adenotonsillectomy in Children; URL: https://clinicaltrials.gov/study/NCT04527393; Identifier: NCT04527393.

The effects of morphine administration on the central nervous system (CNS): advantages and disadvantages

Morphine, a potent opioid analgesic, plays a critical role in pain management but elicits complex effects on the central nervous system (CNS), demonstrating both beneficial and detrimental outcomes. This paper reviews preclinical studies to examine morphine's interactions with the CNS, notably via binding to opioid receptors, leading to analgesia as well as a series of adverse effects, including addiction, tolerance, and neurological impairments. Acute exposure to morphine alters neurotransmitter activity, gene expression, and neuronal firing rates. In contrast, chronic use results in significant neuronal damage, altered memory functions, increased pain sensitivity, and neuroinflammation, highlighting the drug's impact on neurogenesis and neural cell viability. Additionally, morphine's protective properties against neurotoxic insults are discussed, alongside its potential to disrupt cellular and molecular pathways, culminating in neurotoxicity and cognitive deficits. Given the dual nature of morphine's impact on the CNS - protective vs. harmful, depending on specific conditions such as dosage, disease type, and administration frequency - this paper underscores the necessity for further research to untangle this complex interplay to leverage morphine's pain management benefits while minimizing its risks. A thorough evaluation of morphine administration practices can help reconcile these conflicting results.

A Case of Esophagogastric Junction Cancer Treated with Pain Control by Administering Methadone Tablets Through a Gastrostomy.

Introduction: Methadone is used to treat intractable cancer pain when other opioid analgesics are ineffective. Methadone tablets may be difficult to administer in cases of gastrointestinal passage obstruction. However, changing the route of methadone tablet administration is possible. Case Description: The patient, diagnosed with esophagogastric junction cancer with multiple metastases, continued to receive methadone tablets even after not being longer able to take oral medication. Method: Methadone tablets were administered using a simple suspension method via gastrostomy. We measured the respiratory rate during sleep daily. We also measured weekly QTc values using a 12-lead electrocardiogram and methadone blood concentration periodically. No side effects were observed. Conclusion: Using a simple suspension method to administer methadone is a safe pain management method when accompanied by careful monitoring. To date, no study has examined the tube administration safety of methadone tablets. Thus, this case report is of important clinical significance.