Journal of Clinical Oncology, Vol 16, 3656-3661, Copyright © 1998 by American Society of Clinical Oncology
Morphine versus methadone in the pain treatment of advanced-cancer patients followed up at home
S Mercadante, A Casuccio, A Agnello, R Serretta, L Calderone and L Barresi
Pain Relief and Palliative Care, Societa a Maluto Oncologico Terminale, University of Palermo, Italy. mercadsa@tin.it
PURPOSE: The aim of this study was to evaluate the analgesic and adverse
effects and the doses of methadone in comparison to morphine. PATIENTS AND
METHODS: A prospective randomized study was performed in a sample of 40
patients with advanced cancer who required strong opioids for their pain
management. Patients were treated with sustained-release morphine or
methadone in doses titrated against the effect administered two or three
times daily according to clinical need. Opioid doses, adjuvant medications,
symptoms associated with opioid therapy, pain intensity, and pain
mechanisms were recorded. The opioid escalation indices in percentage
(OEI%) and milligrams (OEImg) were calculated. The effective analgesic
score (EAS) that monitors the analgesic consumption-pain ratio was also
calculated at fixed weekly intervals. RESULTS: differences in pain
intensity were found. Patients treated with methadone reported values of
OEI significantly less than those observed in patients treated with
morphine. Seven patients in the methadone group maintained the same initial
dosage until death, whereas only one patient in the morphine group did not
require opioid dose escalation. A more stable analgesia in time in patients
treated with methadone was shown by the low number of gaps in EASs
reported. Symptom frequencies and intensities were similar in the two
groups. CONCLUSION: Methadone is a drug of indisputable value in the
treatment of cancer pain, and an unbalanced focus on the risks of
inappropriate use rather than the benefits should not compromise the use of
a relevant alternative to morphine in the management of cancer pain.
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