This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bruera, E. Articles by Fisch, M. J. Search for Related Content PubMed PubMed Citation Articles by Bruera, E. Articles by Fisch, M. J. Social Bookmarking                            What's this?

Methadone Versus Morphine As a First-Line Strong Opioid for Cancer Pain: A Randomized, Double-Blind Study

From the Department of Palliative Care and Rehabilitation Medicine, the University of Texas M.D. Anderson Cancer Center, Houston, TX; Institute for Oncology and Radiology of Serbia, Belgrade, Yugoslavia-Serbia; Instituto Nacional del Cancer, Santiago, Chile; Departamento de Anestesia, Clinica de Dolor, Fundacion Santafe de Bogota, Bogota, Colombia; Unidad de Cuidados Paliativos Hospital Enrique Tornu-Fundacion FEMEBA, Buenos Aires, Argentina; Nucleo de Oncolgia da Bahia, Bahia, Brazil; and Peter Mac Callum Cancer Institute, Department of Pain and Palliative Care, East Melbourne, Australia.

Address reprint requests to Eduardo Bruera, MD, Department of Palliative Care & Rehabilitation Medicine (Unit 0008), the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-0049; e-mail: Ebruera{at}mail.mdanderson.org.

PURPOSE: To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain.

PATIENTS AND METHODS: Patients in international palliative care clinics with pain requiring initiation of strong opioids were randomly assigned to receive methadone (7.5 mg orally every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained release every 12 hours and 5 mg every 4 hours as needed). The study duration was 4 weeks.

RESULTS: A total of 103 patients were randomly assigned to treatment (49 in the methadone group and 54 in the morphine group). The groups had similar baseline scores for pain, sedation, nausea, confusion, and constipation. Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%) than those receiving morphine (three of 54; 6%; P = .019). The opioid escalation index at days 14 and 28 was similar between the two groups. More than three fourths of patients in each group reported a 20% or more reduction in pain intensity by day 8. The proportion of patients with a 20% or more improvement in pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of patient-reported global benefit were nearly identical to the pain response rates and did not differ between the treatment groups.

CONCLUSION: Methadone did not produce superior analgesic efficiency or overall tolerability at 4 weeks compared with morphine as a first-line strong opioid for the treatment of cancer pain.

Supported in part by the Brown Foundation, Houston, TX, and the Tobacco Settlement Foundation. Florian Strasser is supported by a grant from Swiss Cancer Research (BIL grant KFS 950-09-1999).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K. A. Lorenz, J. Lynn, S. M. Dy, L. R. Shugarman, A. Wilkinson, R. A. Mularski, S. C. Morton, R. G. Hughes, L. K. Hilton, M. Maglione, et al. Evidence for Improving Palliative Care at the End of Life: A Systematic Review Ann Intern Med, January 15, 2008; 148(2): 147 - 159. [Abstract] [Full Text] [PDF]

				E. A. Curry III, S. Palla, F. Hung, R. Arbuckle, and E. Bruera Prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital Am. J. Health Syst. Pharm., August 1, 2007; 64(15): 1619 - 1625. [Abstract] [Full Text] [PDF]

				A. E Patanwala, J. Duby, D. Waters, and B. L Erstad Opioid Conversions in Acute Care Ann. Pharmacother., February 1, 2007; 41(2): 255 - 266. [Abstract] [Full Text] [PDF]

				E. D Bruera and L. De Lima Opioid cost: a global problem Palliative Medicine, September 1, 2005; 19(6): 504 - 504. [PDF]