Metahdone for cancer patients

[Iamnew2]

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Hey all,
Do any of you routinely prescribe methadone for cancer patients? In my area, it seems a number of the docs prescribe Methadone for their cancer patients. Where I did residency pretty much no one prescribed Methadone for just about anything.
Thoughts on this?

 

[painfree23]

Hey all,
Do any of you routinely prescribe methadone for cancer patients? In my area, it seems a number of the docs prescribe Methadone for their cancer patients. Where I did residency pretty much no one prescribed Methadone for just about anything.
Thoughts on this?

No

 

[Iamnew2]

No

thank you for the conciseness 🙂 I agree it's very odd.

 

[Agast]

Methadone is great for certain types of cancer. If you have diffuse bony mets and you try to manage this with oxycodone you are going to find yourself ramping up their MEDs fast. Methadone is way more stabilizing.

 

[Iamnew2]

Methadone is great for certain types of cancer. If you have diffuse bony mets and you try to manage this with oxycodone you are going to find yourself ramping up their MEDs fast. Methadone is way more stabilizing.

what about for focal tumors? I have a patient with lymphoma with an infiltrative mass who was sent on Methadone

 

[Ferrismonk]

That's why they have oncologists.

Seriously though, pain is a symptom and could signal worsening or spreading cancer. Oncologist should be on top of this.
Also, opioids aren't that great for chronic pain either, even for Cancer.

 

[Agast]

what about for focal tumors? I have a patient with lymphoma with an infiltrative mass who was sent on Methadone

I will typically wait to start methadone to see how they do on standard meds. But if you’re getting someone who wants to take hydrocodone 10mg every 3 hours they would probably benefit from some NMDA receptor activity along with the opioid.

 

[Iamnew2]

That's why they have oncologists.

Seriously though, pain is a symptom and could signal worsening or spreading cancer. Oncologist should be on top of this.
Also, opioids aren't that great for chronic pain either, even for Cancer.

Yes the Oncologists sent her on Methadone, which is not something I typically see. Reason I asked. I'm just continuing this med. And yes she has spreading/infiltrative mass and is on chemo/radiation.

 

[Ferrismonk]

Yes the Oncologists sent her on Methadone, which is not something I typically see. Reason I asked. I'm just continuing this med. And yes she has spreading/infiltrative mass and is on chemo/radiation.

That's what I mean. The oncologist should handle his/her own Methadone.

 

[HemeOncHopeful19]

I think I’ve seen our palliative care doc use Methadone a few times.

I usually handle pain meds up front but for some patients at a certain point pain issues can take over the encounter and it takes away from my ability to discuss their chemotherapy and how they’re tolerating it.

What do you guys like people to use while they’re waiting for their palliative appointment? I usually try to use MS-ER and Oxycodone/Hydrocodone breakthrough

 

[Orin]

I prefer methadone to the fentanyl vests. I stay in the 10-30 mg/day range as above I'm likely treating more anxiety/addiction. It's very helpful in cancer patients with the multiple mechanisms of action on pain/mood, a low cost, a long half life independent of delivery mechanism, and absorption in the proximal stomach independent of GI kinetics/obstruction/emesis. When those patients are admitted or lack enteral access, we've got IV methadone at most places.

I agree that chronic opioids are not optimal for the populations, but the patients need to tolerate chemo/radiation/etc to have a chance to even risk those complications and I can't ablate/stimulate/kypho/pump every malignant pain.

 

[NJPAIN]

When I did some cancer pain in academic practice many years ago we frequently seemed to “save the day” by simply suggesting that methadone 5mg q6h be added to the regimen.

 

[lobelsteve]

When I did some cancer pain in academic practice many years ago we frequently seemed to “save the day” by simply suggesting that methadone 5mg q6h be added to the regimen.

Palliative care by me does this. And I get calls from Onc to fix it because no one should die in terrible pain.

 

[NJPAIN]

Palliative care by me does this. And I get calls from Onc to fix it because no one should die in terrible pain.

What’s the fix that palliative care and onc could not provide? A pump?

 

[lobelsteve]

What’s the fix that palliative care and onc could not provide? A pump?

Sometimes a pump, sometimes rational use of opiates for cancer pain.

Fentanyl patches
Exalgo
Actiq
oxy liquid
magic mouthwash
cyproheptadine
glyco
Ativan
Zanaflex
TCA

 

[NJPAIN]

Kudos to you Steve. Those are difficult patients and like trying to hit a moving target as the disease often rapidly progresses and brings with it different types of pain and symptoms. I would think that palliative care docs would be totally prepared to handle this. Perhaps not all are. Not my strong suit.

 

[lobelsteve]

Kudos to you Steve. Those are difficult patients and like trying to hit a moving target as the disease often rapidly progresses and brings with it different types of pain and symptoms. I would think that palliative care docs would be totally prepared to handle this. Perhaps not all are. Not my strong suit.

When they no show, they really no show. Really nice and young lady missed her appointment on Thursday. Got a call earlier in the week from her Onc. Cancer broke through her skin in lots of places and wasn't sure how much longer she had. I was like, is that really a thing?