Therapeutic challenges in cancer pain management: a systematic review of methadone

Good, Phillip, Afsharimani, Banafsheh, Movva, Rayma, Haywood, Alison, Khan, Sohil and Hardy, Janet (2014) Therapeutic challenges in cancer pain management: a systematic review of methadone. Journal of Pain and Palliative Care Pharmacotherapy, 28 3: 197-205. doi:10.3109/15360288.2014.938883


Author Good, Phillip
Afsharimani, Banafsheh
Movva, Rayma
Haywood, Alison
Khan, Sohil
Hardy, Janet
Title Therapeutic challenges in cancer pain management: a systematic review of methadone
Journal name Journal of Pain and Palliative Care Pharmacotherapy   Check publisher's open access policy
ISSN 1536-0539
1536-0288
Publication date 2014-09
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.3109/15360288.2014.938883
Open Access Status
Volume 28
Issue 3
Start page 197
End page 205
Total pages 9
Place of publication New York, NY, United States
Publisher Informa Healthcare
Collection year 2015
Language eng
Abstract The proven therapeutic efficacy of methadone in cancer pain is hindered by a challenging pharmacokinetic-pharmacodynamic profile, considerable interpatient variation, and increasing concern about the complexities of dosing. The objective of this study was to assess the evidence for the use of methadone in cancer pain management. The authors conducted a systematic literature search for randomized controlled trials (RCTs) published post the 2007 Cochrane review of methadone in cancer pain. Trial quality was assessed using the Oxford Quality Scoring System and Cochrane Handbook for Systematic Reviews of Interventions. Of the 152 abstracts found, 4 were RCTs (272 participants). Two RCTs compared the efficacy and safety of methadone with placebo or active control and two investigated rotation to methadone from other opioids. The studies used different routes of administration, dosing, initiation, and titration of methadone and distinct pain scoring tools and did not address the issues raised by the Cochrane review. Methadone has an important role in the management of cancer pain, with many advantages including low cost, high oral bioavailability, rapid onset of action, once-daily dosing, and postulated benefits in difficult pain control scenarios. However, due to limited research in this area, methadone dosing remains a challenge, with vigilant dose initiation, adjustment, and monitoring required. There is a need for further studies using standardized methodology to evaluate the optimal dosing strategy of methadone, the effect on different types of pain, and the role of pharmacokinetics and pharmacogenomics in clinical outcomes.
Keyword Cancer
Humans
Methadone
Pain
Palliative care
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2015 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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