Ragaban Faten, Purohit Om, Del Fabbro Egidio
Division of Palliative Medicine, Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Curr Oncol. 2024 Dec 1;31(12):7613-7624. doi: 10.3390/curroncol31120561.
Cancer-related neuropathic pain (CRNP) is often a significant burden on patients' quality of life. There are limited treatment guidelines for cancer-related neuropathic pain outside of CIPN. Although opioids are considered a third-line treatment option, no consensus exists on which opioid is most effective, either as a single agent or in combination with other medications. Our aim is to review and update the literature for methadone use in CRNP, since the last review was conducted in 2006. A comprehensive literature search was performed to evaluate the use of methadone in cancer-related neuropathic pain. Articles were identified from PubMed, Google Scholar, and Cochrane Library using the following keywords: " AND AND " and "". Studies were included if they evaluated methadone's efficacy or safety in neuropathic pain management for patients with cancer. This review focused on randomized controlled trials (RCTs), systematic reviews, meta-analyses, and observational studies published between 2000 and 2024. Studies were excluded if they lacked specific data on cancer-related neuropathic pain or were case reports. : The unique mechanisms of action and preliminary clinical trials support methadone's status as the first opioid to consider for CRNP when non-opioid first-line treatments have failed to alleviate patient symptoms. Methadone can also be considered as a first-line opioid in patients with mixed nociceptive-neuropathic pain and any of the following features: renal dysfunction; administration of opioids through a feeding tube; a lack of financial resources/insurance; and a switch from another high-dose opioid. More research is needed regarding methadone for CRNP and methadone's preferential use in specific sub-groups of patients.
癌症相关的神经性疼痛（CRNP）常常给患者的生活质量带来沉重负担。除化疗引起的周围神经病变（CIPN）外，针对癌症相关神经性疼痛的治疗指南有限。尽管阿片类药物被视为三线治疗选择，但对于哪种阿片类药物作为单一药物或与其他药物联合使用最为有效，尚无共识。我们的目的是回顾和更新自2006年上次综述以来美沙酮用于CRNP的文献。进行了全面的文献检索，以评估美沙酮在癌症相关神经性疼痛中的应用。使用以下关键词从PubMed、谷歌学术和考克兰图书馆中检索文章：“ AND AND ”和“”。如果研究评估了美沙酮在癌症患者神经性疼痛管理中的疗效或安全性，则纳入研究。本综述重点关注2000年至2024年发表的随机对照试验（RCT）、系统评价、荟萃分析和观察性研究。如果研究缺乏与癌症相关神经性疼痛的具体数据或为病例报告，则排除在外。：独特的作用机制和初步临床试验支持美沙酮在非阿片类一线治疗未能缓解患者症状时作为CRNP首选阿片类药物的地位。对于伴有混合性伤害性-神经性疼痛且具有以下任何特征的患者，美沙酮也可被视为一线阿片类药物：肾功能不全；通过鼻饲管给予阿片类药物；缺乏资金/保险；以及从另一种高剂量阿片类药物转换。关于美沙酮用于CRNP以及美沙酮在特定患者亚组中的优先使用，还需要更多的研究。
