ArticleJournal of palliative medicine2013
The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia.
Article in Journal of palliative medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 80 citations in OpenAlex.
- Opioid Add-On Combination Therapy for Cancer Pain: Pharmacological Rationale, Clinical Evidence, and Future Directions.CNS drugs · 2026Review
- A Review of the Prospective Effects of Methadone on Peripheral Neuropathic Pain in Diabetic Patients.TheScientificWorldJournal · 2025Review
- Novel drug treatments for pain in advanced cancer and serious illness: a focus on neuropathic pain and chemotherapy-induced peripheral neuropathy.Palliative care and social practice · 2024Review
- Direct versus indirect posterior malleolar fixation in the treatment of trimalleolar ankle fractures: Is there a difference in outcomes?OTA international : the open access journal of orthopaedic trauma · 2022Article
- Buprenorphine/naloxone versus methadone opioid rotation in patients with prescription opioid use disorder and chronic pain: study protocol for a randomized controlled trial.Addiction science & clinical practice · 2022Article
- Methadone as First-line Opioid for the Management of Cancer Pain.The oncologist · 2022Article
- First-line methadone for cancer pain: titration time analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- Alleviating Terminal Pediatric Cancer Pain.Children (Basel, Switzerland) · 2021Review
- Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021Article
- Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center.BMC palliative care · 2020Observational
- How to Use Methadone in an Era of an Opioid Epidemic.Current treatment options in oncology · 2020Review
- Article
- Comprehensive Perioperative Management Considerations in Patients Taking Methadone.Current pain and headache reports · 2019Review
- Neuroleptanalgesia for acute abdominal pain: a systematic review.Journal of pain research · 2019Review
- Methadone as anticancer treatment: hype, hope, or hazard? : A series of case reports and a short review of the current literature and recommendations of the societies.Wiener medizinische Wochenschrift (1946) · 2018Review
- When to Use Methadone for pain: A Case-Based Approach.Indian journal of palliative care · 2018Review
- Opioid-induced myoclonus and hyperalgesia following a short course of low-dose oral morphine.British journal of pain · 2017Article
- Methadone as first-line opioid treatment for cancer pain in a developing country palliative care unit.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2016Article
- Methadone in Cancer Pain.Indian journal of palliative careArticle
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOpioid dose escalation may cause hyperalgesia, mediated by the N-methyl-D-aspartate (NMDA) pathway. Methadone is an atypical opioid that inhibits hyperalgesia through NMDA-blockade, especially at low doses.
objectiveTo evaluate the efficacy of using very-low-dose methadone as the sole long-acting opioid agent in a hospice practice.
designA retrospective, observational study of the use of methadone, ≤15 mg daily, with as-needed short-acting opiates. Adjuvant nonopioid medications included haloperidol, which may have NMDA-blocking effects. SETTING/SUBJECTS: We reviewed the records of 240 patients admitted to a community-based hospice from July 1, 2011 to April 1, 2012, with data collected until hospice discharge or until April 30, 2012. MEASUREMENTS: Descriptive statistics were used to summarize patient demographics, medication regimens, and reported pain scores measured on a numeric rating scale from 0 to 10.
resultsAll patients received short-acting opiates, in a morphine-equivalent dose of 5 mg every 4 hours as needed, while 40% also received methadone at a median daily dose of 5 mg. Of those on methadone, almost half received scheduled haloperidol. The population had a median reported pain score of 0 and a peak score of 3, with similar results seen for cancer and noncancer groups. Two-thirds of patients never reported a pain score greater than 3.
conclusionThe use of very-low-dose methadone in conjunction with adjuvant haloperidol resulted in excellent pain control without dose escalation or opioid-induced hyperalgesia, for both cancer and noncancer diseases. We conclude that low-dose methadone should be part of first-line treatment in palliative pain management.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.