1 Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas.
2 Department of Palliative Care, Dell Seton Medical Center, The University of Texas , Austin, Texas.
J Palliat Med. 2018 Sep;21(9):1317-1321. doi: 10.1089/jpm.2017.0712. Epub 2018 Apr 17.
Methadone is an attractive medication for treating children with advanced cancer with pain as it is the only long-acting opioid available as a liquid. However, it is not frequently used due to concerns about potential toxicities and side effects.
Evaluate the efficacy and safety of methadone as the first long-acting opioid in children with advanced cancer.
Retrospective chart review of 52 consecutive patients referred to Pediatric Supportive Care for pain management started on methadone as their first long-acting opioid. Data collected at baseline, follow-up visits #1 (F1) and #2 (F2) included child and parent-reported outcomes for various physical and psychological symptoms, opioid side effects and other clinical data. Symptoms were rated on a 0 (not at all) to 4 (a lot) scale.
Pain (mean ± standard deviation [SD]) scored by the child was 3.6 (±0.6)/4 at baseline and 1.8 (±1.1)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the child at F2 was 1.2 (±1.3)/4 (p < 0.0001). Pain scored by the parent was 3.5 (±0.7)/4 at baseline and 1.4 (±1.3)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the parent at F2 was 1.0 (±1.2)/4 (p < 0.0001). Thirty-three (70%) patients at F1 and 23 (79%) patients at F2 did not need a change in dose of methadone. No cardiac arrhythmias or opioid neurotoxicity was observed.
Initiation of methadone was effective and safe as the first long-acting opioid in children with pain.
美沙酮是治疗晚期癌症疼痛儿童的一种有吸引力的药物，因为它是唯一可作为液体使用的长效阿片类药物。然而，由于担心潜在的毒性和副作用，它并不经常使用。
评估美沙酮作为晚期癌症儿童的第一种长效阿片类药物的疗效和安全性。
回顾性分析了 52 例连续患者的病历，这些患者因疼痛管理而转至儿科支持治疗中心，开始使用美沙酮作为他们的第一种长效阿片类药物。在基线、随访 1 次（F1）和随访 2 次（F2）时收集了儿童和家长报告的各种身体和心理症状、阿片类药物副作用和其他临床数据。症状按 0（一点也不）至 4（很多）的量表评分。
儿童自我报告的疼痛（平均值±标准差[SD]）在基线时为 3.6（±0.6）/4，在 F1 时为 1.8（±1.1）/4（p<0.0001）。与基线相比，儿童在 F2 时的疼痛评分为 1.2（±1.3）/4（p<0.0001）。家长报告的疼痛在基线时为 3.5（±0.7）/4，在 F1 时为 1.4（±1.3）/4（p<0.0001）。与基线相比，家长在 F2 时的疼痛评分为 1.0（±1.2）/4（p<0.0001）。在 F1 时有 33（70%）例患者和在 F2 时有 23（79%）例患者不需要改变美沙酮的剂量。未观察到心律失常或阿片类药物神经毒性。
作为晚期癌症疼痛儿童的第一种长效阿片类药物，美沙酮的起始治疗是有效且安全的。
