Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2024 Feb;67(2):e147-e150. doi: 10.1016/j.jpainsymman.2023.10.018. Epub 2023 Oct 18.
Methadone is a commonly prescribed opioid amongst cancer patients. It has unique pharmacological properties which can benefit in treating complex pain syndromes and neuropathic pain. However, strict guidelines have been created in a generalized manner for chronic pain and long-term survival patients. These guidelines, such as QT interval monitoring can lead to limitations for methadone use in patients with comfort-associated goals. We present two cases of patients with metastatic cancer who were treated for pain with methadone and had to undergo opioid rotation due to abnormal QT intervals.
Case one was a female with open ulcerated wounds due to metastatic breast cancer who presented with uncontrolled pain on her current opioid regimen. She achieved pain relief when rotated to methadone but a repeat electrocardiogram a few months later showed QTc prolongation. She underwent opioid rotation with different medications, but her pain remained poorly controlled. Case two was a female with poorly controlled pain in the setting of bilateral breast cancer. She presented with concerns for opioid-induced neurotoxicity and was rotated to methadone. She achieved optimal pain relief. A few weeks later, her machine read QT interval was prolonged and she was rotated off methadone. The electrocardiogram was manually read which showed a normal QT interval and she was restarted on methadone with pain relief.
In the palliative care setting, monitoring QTc per chronic pain guidelines may lead to uncontrolled pain and a significant impact on quality of life.
美沙酮是癌症患者常用的一种阿片类药物。它具有独特的药理学特性，可用于治疗复杂的疼痛综合征和神经病理性疼痛。然而，针对慢性疼痛和长期生存患者，已制定了一般性的严格指南。这些指南，如 QT 间期监测，可能会限制有舒适相关目标的患者使用美沙酮。我们介绍了两例转移性癌症患者的病例，他们因 QT 间期异常而不得不进行阿片类药物转换以接受美沙酮治疗疼痛。
病例一为一名患有转移性乳腺癌的女性，其开放性溃疡伤口导致疼痛无法控制，目前的阿片类药物治疗方案无效。她改用美沙酮后疼痛得到缓解，但几个月后复查心电图显示 QTc 延长。她改用了其他药物进行阿片类药物转换，但疼痛仍未得到很好的控制。病例二为一名双侧乳腺癌患者，疼痛控制不佳。她担心阿片类药物引起的神经毒性，因此被转用美沙酮。她的疼痛得到了很好的缓解。几周后，她的机器读取的 QT 间期延长，她被停用美沙酮。手动阅读心电图显示 QT 间期正常，她重新开始使用美沙酮，疼痛得到缓解。
在姑息治疗环境中，根据慢性疼痛指南监测 QTc 可能导致疼痛无法控制，并对生活质量产生重大影响。
