Methadone should be considered as a treatment of cancer pain with a neuropathic component for patients with head and neck cancer, according to a study published in the European Journal of Cancer.1
Researchers in the Netherlands conducted a randomized, controlled trial of 52 strong opioid-naive patients with head and neck cancer, each of whom had substantial pain with a neuropathic component.
They treated 26 patients with methadone and expected better pain relief compared to 26 patients treated with fentanyl. Patients were evaluated at 1, 3 and 5 weeks, with primary outcomes being reduction in average pain, clinical success, and reduction in pain interference.
Reductions in Numeral Rating Scale for pain were better with the use of methadone at 1, 3 and 5 weeks compared to fentanyl, with a significant difference at 1 and 3 weeks. Clinical success, defined as a more than 50% improvement, was higher with methadone at 1 week.
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Changes in pain interference, global perceived effect, and side effect profile were not found to differ between the groups.
- Haumann J, Geurts JW, van Kuikl SM, et al. Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer. Eur J Cancer. 2016 Aug 2. doi: 10.1016/j.ejca.2016.06.025 [Epub ahead of print]