Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden.
PLoS One. 2020 Apr 10;15(4):e0230845. doi: 10.1371/journal.pone.0230845. eCollection 2020.
Despite being associated with dependence and social stigma, methadone is a potential end-of-life option in complex cancer pain.
To explore attitudes and opinions about methadone and its potential role and current use in complex end-of-life pain.
Semi-structured interviews (n = 30) with physicians in specialized palliative care, transcribed and analyzed with conventional qualitative content analysis.
According to the physicians, patients and relatives expressed unexpectedly few negative attitudes, not affecting methadone's use as an analgesic. Complex pain in bone-metastatic cancer of the prostate, breast and kidney, as well as pancreatic cancer and sarcomas were recurrent suggestions of appropriate indications. Most of the informants stated that they applied a mechanism-based treatment and mainly prescribed low-dose methadone as an add-on to an existing opioid therapy to benefit from methadone´s proposed NMDA-receptor inhibiting properties, e.g. in cases with reduced opioid sensitivity. Despite its complex pharmacokinetics with a long half-life, most informants expressed defined strategies to avoid side-effects such as respiratory depression, especially when initiating treatment in the home-care setting. While many palliative care physicians expressed an overly enthusiastic attitude, others stressed the risks of overconfidence, low precision in use, and overlooked treatment options. Besides the obvious physical pain-relieving effects, they stated that effective pain relief could result in a reduced workload and emotional empowerment, both for physicians and staff.
Methadone, especially in the form of low-dose add-on to other opioids is widely advocated in Swedish specialized palliative care as a practical and safe method with rapid onset in complex pain situations at the end of life.
尽管美沙酮与依赖和社会耻辱有关，但它是复杂癌症疼痛临终选择的潜在药物。
探索对美沙酮及其在复杂临终疼痛中的潜在作用和当前使用的态度和意见。
对专门从事姑息治疗的医生进行半结构化访谈（n=30），并使用常规定性内容分析对访谈内容进行转录和分析。
根据医生的说法，患者和家属的态度出乎意料地没有那么消极，这并没有影响美沙酮作为一种止痛剂的使用。前列腺癌、乳腺癌和肾癌骨转移、胰腺癌和肉瘤等复杂疼痛，以及对低剂量美沙酮的应用，被反复认为是合适的适应症。大多数受访者表示，他们采用基于机制的治疗方法，主要将低剂量美沙酮作为现有阿片类药物治疗的附加药物，以受益于美沙酮所提出的 NMDA 受体抑制特性，例如在阿片类药物敏感性降低的情况下。尽管美沙酮的药代动力学复杂，半衰期长，但大多数受访者表示有明确的策略来避免副作用，如呼吸抑制，尤其是在家庭护理环境中开始治疗时。虽然许多姑息治疗医生表现出过度热情的态度，但其他人强调了过度自信、使用精度低和忽视治疗选择的风险。除了明显的缓解身体疼痛的效果外，他们还表示，有效的疼痛缓解可以减轻医生和工作人员的工作负担和情绪压力。
在瑞典专门的姑息治疗中，美沙酮（尤其是作为其他阿片类药物的低剂量附加药物）被广泛提倡作为一种实用且安全的方法，在生命末期复杂疼痛情况下起效迅速。
