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. doi: 10.1200/JCO.2004.03.172.

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.

Publication types

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

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / pharmacology
  • Analgesics, Opioid / therapeutic use*
  • Delayed-Action Preparations
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Methadone / adverse effects
  • Methadone / pharmacology
  • Methadone / therapeutic use*
  • Middle Aged
  • Neoplasms / complications*
  • Pain / drug therapy*
  • Pain / etiology*
  • Palliative Care
  • Patient Dropouts
  • Patient Satisfaction

Substances

  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Methadone