Evidence map›Paper›PMID 34938934›Full record

ArticlePain reports

Use of methadone as an alternative to morphine for chronic pain management: a noninferiority retrospective observational study.

Guilherme Antonio Moreira de Barros, Ricardo Baradelli, Debora Garcia Rodrigues, Odaly Toffoletto, Flavia Seullner Domingues, Maisa Vitoria Gayoso, Alexandre Lopes, Jorge Barros Afiune, Gabriel Magalhães Nunes Guimarães

Open access · goldAbstract read
In one paragraph

Article in Pain reports. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Opioid analgesic dose and route conversion ratio studies: a scoping review to inform an eDelphi guideline.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024
    Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Guilherme Antonio Moreira de BarrosSurgical Specialties and Anesthesiology Department, Sao Paulo State University (UNESP) Medical School-UNESP, Botucatu - SP, Brazil.
Ricardo BaradelliClinical Research, Cristália Produtos Químicos Farmacêuticos, Sao Paulo - SP, Brazil.
Debora Garcia RodriguesMedical Affairs, Cristália Produtos Químicos Farmacêuticos, Brazil.
Odaly ToffolettoClinical Research, Cristália Produtos Químicos Farmacêuticos, Sao Paulo - SP, Brazil.
Flavia Seullner DominguesSurgical Specialties and Anesthesiology Department, Sao Paulo State University (UNESP) Medical School-UNESP, Botucatu - SP, Brazil.
Maisa Vitoria GayosoSurgical Specialties and Anesthesiology Department, Sao Paulo State University (UNESP) Medical School-UNESP, Botucatu - SP, Brazil.
Alexandre LopesSurgical Specialties and Anesthesiology Department, Sao Paulo State University (UNESP) Medical School-UNESP, Botucatu - SP, Brazil.
Jorge Barros AfiuneMedical Affairs, Cristália Produtos Químicos Farmacêuticos, Brazil.
Gabriel Magalhães Nunes GuimarãesSurgical Area, Medical School, Brasilia Federal University (UnB), Brasilia - DF, Brazil.
Cristalia (Brazil) · BRUniversidade Estadual Paulista (Unesp) · BRUniversidade de Brasília · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic pain causes disability and is prevalent in the general population. Opioids are a part of a multimodal strategy for pain management. Methadone, a cheap and long-acting synthetic opioid, may represent an option for those who have limited access to the aforementioned class of analgesics. We aimed to provide a real-world evidence for the analgesic use of methadone, compared with morphine.

methodsWe conducted a noninferiority, retrospective observational single center study of patients with chronic pain, managed with either methadone or morphine at an outpatient specialized clinic. We extracted data from the electronic health records of patients who underwent an active treatment between August 2012 and January 2020 and were examined for at least 2 consecutive medical visits, after the administration of one of the aforementioned drugs. Data were analyzed using a generalized additive model with random-effects mixed linear method to account for the individual-related, time-related, and drug-related variations. The numeric verbal scale (0-10) was used to assess the pain severity.

resultsFrom the database of 3373 patients, we included 262 patients (175 methadone and 87 morphine). In an unadjusted analysis, methadone was superior to morphine, and the mean worst pain was 0.86 points lower (95% confidence interval, -1.29 to -0.43). Moreover, methadone was superior to morphine in the adjusted analysis, with the worst pain mean being 1.24 points lower. This provided evidence for the noninferiority of methadone than morphine.

conclusionMethadone was superior to morphine in a 20% noninferiority margin for reducing worst pain.

Indexed as

Chronic painMethadoneMorphineNoninferiority trialsOpioid analgesics

Identifiers

PMID34938934
PMCPMC8687725
OpenAlexW4200221765

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.