Methadone May Be Superior to Fentanyl for Neuropathic Pain

Methadone May Be Superior to Fentanyl for Neuropathic Pain
Methadone May Be Superior to Fentanyl for Neuropathic Pain

Methadone appears to be superior to fentanyl for the treatment of neuropathic pain in patients with head and neck cancer, a study published in the European Journal of Cancer has shown.1

Cancer pain continues to be inadequately treated in the majority of patients with cancer. Because methadone affects the N-Methyl-d-Aspartate receptor, researchers hypothesized that methadone could provide better pain relief than fentanyl in cancer pain with a neuropathic pain component.

For the study, investigators enrolled 52 patients with head and neck cancer and substantial pain and a neuropathic pain component who had not received strong opioids. Participants were randomly assigned 1:1 to receive methadone or fentanyl.

Patients were then evaluated at 1, 3, and 5 weeks to assess reduction in average pain, reduction in pain interference, clinical success, which was defined as a 50% average pain decrease, global perceived effect, and adverse events.

Results showed that reduction in average pain was higher with methadone treatment at all 3 time points compared with fentanyl, with significant differences in average pain reductions at 1 week (P =.011) and 3 weeks (P =.03).

Researchers also found that clinical success was achieved in a significantly higher proportion of methadone-treated patients at week 1 (50% vs 15%; P =.012).

Of note, there were no significant differences in pain interference, global perceived effect, or toxicity profile between the 2 treatment arms.

The findings ultimately suggest that methadone should be considered for the treatment of neuropathic pain in this patient population.

Reference

1. Haumann J, Geurts JW, van Kuijk SM, Kremer B, Joosten EA, van den Beuken-van Everdingen MH. Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer. Eur J Cancer. 2016;65:121-129.

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