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J Pain Symptom Manage. 2004 Dec;28(6):619-25.

Characterization of the early pharmacodynamic profile of oral methadone for cancer-related breakthrough pain: a pilot study.

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  • 1Alberta Cancer Board Palliative Research Initiative, Calgary, Canada.


Methadone is effective for chronic cancer pain, but its early pharmacodynamic profile and effectiveness for breakthrough pain remain uncertain. This was an open-label, non-randomized, crossover study comparing the use of oral methadone for breakthrough pain with patients' usual opioid. Study variables included pain intensity (pretreatment and at 10-minute intervals post treatment), treatment-related side effects, and treatment satisfaction. In 37 discrete episodes of breakthrough pain, onset of analgesic effect of a titrated dose of oral methadone was rapid for all patients; 3 of 6 study patients experienced an onset of relief by 10 minutes post-ingestion. The adverse effect profile of oral methadone was not different from patients' usual 'rescue' opioid, and patients were moderately to completely satisfied with oral methadone as a breakthrough pain medication. These observations suggest that oral methadone can have a rapid onset of analgesic action and may have a legitimate role in the management of cancer-related breakthrough pain.

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