Abstract | BACKGROUND: OBJECTIVE: The purpose of this study was to determine the dose ratio between equianalgesic doses of high dose oral morphine (daily doses >1200 mg morphine or MED) and oral methadone. METHODS: This study was a retrospective chart review of 324 patients who received methadone at Strong Memorial Hospital or the associated outpatient clinic during a nine-month period in 2011. Ten patients met the study inclusion and exclusion criteria. A Wilcoxon signed-rank test was used to compare the pain scale scores. The Spearman correlation coefficient was used to assess level of correlation between morphine dose and methadone dose. RESULTS: Patients rotated to methadone from high opioid doses had a two-point improvement in median pain scale scores after conversion (p=0.039). However, there was no correlation identified for patients taking daily doses >1200 mg oral morphine or MED prior to methadone rotation (p=0.19). There were no reported methadone adverse effects during the study. CONCLUSIONS: No correlation was identified between high MED doses and methadone at dose stabilization after opioid rotation. A fixed maximum methadone dose of 30 mg/day produced clinically meaningful improvements in pain scores without adverse drug effects. Caution should be exercised before considering rotation to methadone doses higher than 30 mg/day in a patient receiving >1200 mg oral MED/day.
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Authors | Megan S Chatham, Elizabeth S Dodds Ashley, Jefferson S Svengsouk, Katherine M Juba |
Journal | Journal of palliative medicine
(J Palliat Med)
Vol. 16
Issue 8
Pg. 947-50
(Aug 2013)
ISSN: 1557-7740 [Electronic] United States |
PMID | 23662952
(Publication Type: Journal Article)
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Chemical References |
- Analgesics, Opioid
- Morphine
- Methadone
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Topics |
- Administration, Oral
- Adult
- Analgesics, Opioid
(administration & dosage, therapeutic use)
- Dose-Response Relationship, Drug
- Female
- Hospice Care
(methods, standards)
- Humans
- Male
- Medical Records
(statistics & numerical data)
- Methadone
(administration & dosage, therapeutic use)
- Middle Aged
- Morphine
(administration & dosage, therapeutic use)
- New York
- Pain Measurement
- Pain, Intractable
(drug therapy)
- Palliative Care
(methods, standards)
- Retrospective Studies
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