The Use of Methadone in Adult Patients with Cancer Pain at a Governmental Cancer Center in India

Abstract

Background: Management of cancer-related pain relies on the access to opioids. When regular opioids as morphine are not tolerated or are insufficient, adjuvant opioids as methadone are an affordable and effective analgesic.

Aim: The aim of the project was to describe the pattern of use and clinical experiences of methadone in patients with cancer-related pain at a low-resource hospital in Hyderabad, one of few Indian cancer centers with permission to prescribe methadone.

Methods: Medical records of all patients who had been prescribed methadone, September 9, 2017 and November 19, 2019 were studied retrospectively. Data on analgesic treatment and opioid side effects were analyzed.

Results: A total of 93 adult cancer patients were included in the study. A majority of patients (79%) were prescribed opioid analgesic, mainly morphine, before methadone introduction. The initial daily dose of methadone ranged between 5 and 22.5 years and in the vast majority of the patients 5 mg, divided in two daily administrations. A good analgesic effect, with decreased pain, was reported in 60% of the patients. No severe side effects were reported.

Conclusions: In this study, methadone as a primary opioid was used with a good analgesic effect for cancer pain in a low-resource setting. Indication for methadone was mainly uncontrolled pain with a regular opioid treatment. No severe adverse effects were reported. Further research and prospective studies are needed on methadone treatment in low-resource settings to establish the robust guidelines to support prescribing physicians.

Keywords: Cancer; methadone; opioid; pain; palliative care.

Figure 2

Dose titration of methadone during the first three prescriptions of methadone, both tablet and oral suspension (mg). Each line represents one patient. The time interval between the first, second, and third prescription varied widely

Figure 1

Box plot describing the number of days on methadone treatment among patients who received methadone prescriptions more than once (73/93). Duration was median 49 (2–398) days

Figure 3

Patients' pain experience from the first to the last assessment of methadone treatment. Pain was assessed from patients' records according to “pain relief” (numerical rating scale 0), “mild pain” (numerical rating scale 1–3), “pain” (numerical rating scale 4-6) and “severe pain” (numerical rating scale 7–10). Information regarding assessment was missing in 30/93 patients. Patients' experience of pain, defined as reduction in the pain estimation instrument, decreased in 38/63. In 8/63 of patients, the pain increased and 17/63 did not feel any change