Methadone Versus Morphine for Moderate to Severe Cancer-Related Pain: A Double-Blind Randomized Parallel Group Study
Overview
- Phase
- Phase 2
- Intervention
- Methadone
- Conditions
- Neoplasms
- Sponsor
- Mayo Clinic
- Enrollment
- 1
- Locations
- 1
- Primary Endpoint
- Change in Numeric Pain Scale Score
- Status
- Terminated
- Last Updated
- 10 years ago
Overview
Brief Summary
The purpose of this study is to compare methadone with morphine in the management of moderate to severe cancer pain.
Detailed Description
Treatment of cancer pain is based on the World Health Organization (WHO) step ladder approach to the use of analgesic drugs. Medication potency increases at each step of the WHO ladder, from nonopioid (step 1; e.g., aspirin and nonsteroidal anti-inflammatory drugs) through weak opioids (step 2; e.g. codeine) plus a nonopioid to strong opioids (step 3; e.g., morphine) plus a nonopioid analgesic. Morphine is considered the gold standard for the treatment of moderate to severe pain, but this is based on level C criteria. Research has discovered that methadone is a potent opioid that operates at several levels which are important for pain control. The primary aim is to compare morphine versus methadone as a first-line analgesic in patients with moderate to severe cancer pain. Patients will be randomized to receive either oral slow-release morphine (15 mg) every 8 hours and immediate-release morphine (10 mg) every 4 hours as needed for breakthrough pain or oral methadone 2.5 mg every 8 hours and methadone 2.5 mg every 4 hours as needed for breakthrough pain. Our hypothesis is that methadone will provide equivalent pain control efficacy after 4 weeks of therapy. We postulate that methadone will be as preferable as morphine as an analgesic. We will compare the two drugs via adverse effects and compare stability of analgesia via comparison of the number of breakthrough pain episodes. The study will attempt to establish equivalency of methadone as a first-line analgesic for moderate to severe cancer pain.
Investigators
Donald W. Northfelt, M.D.
MD
Mayo Clinic
Eligibility Criteria
Inclusion Criteria
- •Must have a telephone
- •Age: patient must be 18 years or older and less than 70 years of age
- •Life expectancy of 3 months or greater
- •No prior use of step-3 opioids (step 2 opioids are allowed)
- •Provision of informed consent
- •Score of 26 or greater on Mini-Mental Status Exam (MMSE) (to be done by investigator if there is question about mental status)
- •Nonmalignant pain will be excluded; however, if the patient has both malignant and nonmalignant pain, entry into the trial will be determined by the predominant site of pain
- •Moderate to severe cancer related pain that requires the use of step-3 opioids
- •Normal renal function
- •There will be no exclusionary criteria based on Karnofsky score
Exclusion Criteria
- •Nursing home patients
- •Obvious cognitive dysfunction
- •Intractable nausea or vomiting
- •A true allergy or intolerance to opioids
- •Unstable renal function
- •Undergoing therapeutic procedures likely to influence pain during the study period
- •Gastrointestinal pathology or surgery that influences absorption of morphine or methadone
- •Must not have had treatment with radiotherapy, chemotherapy or radionuclides in the last 30 days
- •History of drug seeking behavior
- •Respiratory compromise
Arms & Interventions
Methadone
Oral methadone 2.5 mg every 8 hours, and oral methadone 2.5 mg every 4 hours as needed for breakthrough pain.
Intervention: Methadone
Morphine
Oral slow-release morphine (15 mg) every 8 hours, and immediate-release morphine (10 mg) every 4 hours as needed for breakthrough pain.
Intervention: Morphine
Outcomes
Primary Outcomes
Change in Numeric Pain Scale Score
Time Frame: Baseline, Week 4
Subjects will be verbally questioned about their pain on a scale from 0 to 10, with 0 being symptoms are absent to 10, the worst possible pain. Response to treatment is defined as a 33% reduction in pain score from the baseline to the Week 4 pain score.
Secondary Outcomes
- Change in Numeric Pain Scale Score(48 hours)