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Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.
J Clin Oncol. 2004 Jan 01; 22(1):185-92.JC

Abstract

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.

Authors+Show Affiliations

Department of Palliative Care & Rehabilitation Medicine (Unit 0008), the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-0049, USA. Ebruera@mail.mdanderson.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14701781

Citation

Bruera, Eduardo, et al. "Methadone Versus Morphine as a First-line Strong Opioid for Cancer Pain: a Randomized, Double-blind Study." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 22, no. 1, 2004, pp. 185-92.
Bruera E, Palmer JL, Bosnjak S, et al. Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study. J Clin Oncol. 2004;22(1):185-92.
Bruera, E., Palmer, J. L., Bosnjak, S., Rico, M. A., Moyano, J., Sweeney, C., Strasser, F., Willey, J., Bertolino, M., Mathias, C., Spruyt, O., & Fisch, M. J. (2004). Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 22(1), 185-92.
Bruera E, et al. Methadone Versus Morphine as a First-line Strong Opioid for Cancer Pain: a Randomized, Double-blind Study. J Clin Oncol. 2004 Jan 1;22(1):185-92. PubMed PMID: 14701781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study. AU - Bruera,Eduardo, AU - Palmer,J Lynn, AU - Bosnjak,Snezana, AU - Rico,Maria Antonieta, AU - Moyano,Jairo, AU - Sweeney,Catherine, AU - Strasser,Florian, AU - Willey,Jie, AU - Bertolino,Mariela, AU - Mathias,Clarissa, AU - Spruyt,Odette, AU - Fisch,Michael J, PY - 2004/1/1/pubmed PY - 2004/1/28/medline PY - 2004/1/1/entrez SP - 185 EP - 92 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 22 IS - 1 N2 - 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. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/14701781/Methadone_versus_morphine_as_a_first_line_strong_opioid_for_cancer_pain:_a_randomized_double_blind_study_ L2 - https://ascopubs.org/doi/10.1200/JCO.2004.03.172?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -