Indications, efficacité et tolérance de la méthadone sur les douleurs cancéreuses : expérience de l'équipe du CETD de l'IGR en 2008

In France the use of methadone is merely authorized for addicted patients, despite its efficacy proven in clinical studies on cancer pain. More studies are needed to base its efficacy on neuropathic component of pain. We retrospectively study indications, efficacy, and tolerance of methadone in patients suffering from refractory cancer pain in our clinical practice. Mean age is 53 years old, 13 are women and six men, 16 had progressive disease, and all referred pain as mixed or neuropathic. Eighteen out of 19 had antidepressant or antiepileptic drugs associated with opioids, 13 out of 19 had at least two opioids in the last three months. Methadone was proposed mainly because of unrelieved pain by current therapies. The average dose of oral daily morphine prior to rotation was 357 mg (40-1008). The titrated dose of methadone on day 7 (n = 19) was 57 mg (15-120). Seventeen patients on day 7 (n = 19) and 15 on day 28 (n = 16) had an average pain < 3 on VAS. Reasons for withdrawal of methadone were impossibility of oral intake (n = 5), unavailability of methadone at home (n = 2), or inefficiency (n = 1). Methadone seems a good option for refractory neuropathic cancer pain, when done by an experienced team.