Open Access Open Access  Restricted Access Subscription or Fee Access

Methadone use in children and young adults at a cancer center: A retrospective study

Doralina L. Anghelescu, MD, Lane G. Faughnan, RN, Gisele M. Hankins, RN, Deborah A. Ward, PharmD, Linda L. Oakes, RN, CNS


Objective: To augment the literature on methadone applications in pediatric oncology, the authors reviewed the use of methadone at a pediatric cancer center over a 5-year period.
Design and setting: Forty-one patients received methadone for inpatient or outpatient pain management. The authors retrospectively reviewed their demographic characteristics, diagnoses, type of pain (nociceptive, neuropathic, or mixed) and causes of pain, and the indications, dose regimens, adverse effects, and outcomes of methadone treatment.
Results: There were four types of clinical uses for methadone in 41 patients (10 patients had two): nociceptive pain unresponsive to other opioids (17 patients, 33.3 percent), neuropathic pain (20 patients, 39.2 percent), facilitation of weaning from opioids (11 patients, 21.6 percent), and end-of-life pain management (3 patients, 5.9 percent). The mean age of the 24 males (58.5 percent) and 17 females (41.5 percent) at the start of treatment was 15.7 years (range, 0.6-23 years). The most common diagnoses were leukemia (n = 10, 24.4 percent), osteosarcoma (n= 7, 17.0 percent), and rhabdomyosarcoma (n = 5, 12.2 percent). The causes of pain were bone marrow transplant (n = 13, 31.7 percent), amputation (n = 6, 14.6 percent), chemotherapy (n = 5, 12.2 percent), tumor (n = 5, 12.2 percent), limb-sparing surgery (n = 4, 9.8 percent), and other (n = 8, 19.5 percent). Efficacy was assessed at the end (or after 6 months) of methadone treatment. For many patients (43.1 percent), methadone showed efficacy in achieving the purpose for which it was prescribed, including reduction of nociceptive or neuropathic pain and prevention of opioid withdrawal. Sedation was the most common side effect (24.4 percent).
Conclusions: Methadone was effective for pediatric patients with neuropathic pain or nociceptive pain unresponsive to other opioids, and it effectively prevented opioid withdrawal.


methadone, pain, analgesia, withdrawal, weaning, neuropathic, pediatric cancer

Full Text:



Nicholson AB: Methadone for cancer pain. Cochrane Database Syst Rev. 2007; (4): CD003971.

Bruera E, Palmer JL, Bosnjak S, et al.: Methadone versus morphine as a first-line strong opioid for cancer pain: A randomized, double-blind study. J Clin Oncol. 2004; 22(1): 185-192.

Jacob E: Neuropathic pain in children with cancer. J Pediatr Oncol Nurs. 2004; 21(6): 350-357.

Anghelescu D, Oakes L, Popenhagen M: Management of cancer pain in neonates, children and adolescents. In de Leon-Casasola OA (ed.): Cancer Pain: Pharmacological, Interventional and Palliative Care Approaches. 1st ed. Philadelphia: Saunders Elsevier, 2006: 509-521.

Manfredi PL, Houde RW: Prescribing methadone, a unique analgesic. J Support Oncol. 2003; 1(3): 216-220.

Ripamonti C, Bianchi M: The use of methadone for cancer pain. Hematol Oncol Clin North Am. 2002; 16(3): 543-555.

Davies D, DeVlaming D, Haines C: Methadone analgesia for children with advanced cancer. Pediatr Blood Cancer. 2008; 51(3): 393-397.

Moulin DE, Clark AJ, Gilron I, et al.: Pharmacological management of chronic neuropathic pain—Consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag. 2007; 12(1): 13-21.

Gorman AL, Elliott KJ, Inturrisi CE: The d- and l-isomers of methadone bind to the non-competitive site on the N-methyl-D-aspartate (NMDA) receptor in rat forebrain and spinal cord. Neurosci Lett. 1997; 223(1): 5-8.

Gourlay GK, Cherry DA, Cousins MJ: A comparative study of the efficacy and pharmacokinetics of oral methadone and morphine in the treatment of severe pain in patients with cancer. Pain. 1986; 25(3): 297-312.

Eap CB, Cuendet C, Baumann P: Binding of d-methadone, l-methadone, and dl-methadone to proteins in plasma of healthy volunteers: Role of the variants of alpha 1-acid glycoprotein. Clin Pharmacol Ther. 1990; 47(3): 338-346.

Abramson FP: Methadone plasma protein binding: Alterations in cancer and displacement from alpha 1-acid glycoprotein. Clin Pharmacol Ther. 1982; 32(5): 652-658.

Gourlay GK, Wilson PR, Glynn CJ: Pharmacodynamics and pharmacokinetics of methadone during the perioperative period. Anesthesiology. 1982; 57(6): 458-467.

Berde CB, Sethna NF, Holzman RS, et al.: Pharmacokinetics of methadone in children and adolescents in the perioperative period. Anesthesiology. 1987; 67(3): A519.

Berde CB, Beyer JE, Bournaki MC, et al.: Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7-year-old children. J Pediatr. 1991; 119(1, Part 1): 136-141.

Sawe J: High-dose morphine and methadone in cancer patients. Clinical pharmacokinetic considerations of oral treatment. Clin Pharmacokinet. 1986; 11(2): 87-106.

Yang F, Tong X, McCarver DG, et al.: Population-based analysis of methadone distribution and metabolism using an age-dependent physiologically based pharmacokinetic model. J Pharmacokinet Pharmacodyn. 2006; 33(4): 485-518.

Shaiova L, Berger A, Blinderman CD, et al.: Consensus guideline on parenteral methadone use in pain and palliative care. Palliat Support Care. 2008; 6(2): 165-176.

Mercadante S: Cancer pain management in children. Palliat Med. 2004; 18(7): 654-662.

Parsons HA, de la Cruz M, El Osta B, et al.: Methadone initiation and rotation in the outpatient setting for patients with cancer pain. Cancer. 2010; 116(2): 520-528.

Leppert W: The role of methadone in cancer pain treatment—A review. Int J Clin Pract. 2009; 63(7): 1095-1109.

Lynch ME: A review of the use of methadone for the treatment of chronic noncancer pain. Pain Res Manag. 2005; 10(3): 133-144.

Moulin DE, Palma D, Watling C, et al.: Methadone in the management of intractable neuropathic noncancer pain. Can J Neurol Sci. 2005; 32(3): 340-343.

Hays L, Reid C, Doran M, et al.: Use of methadone for the treatment of diabetic neuropathy. Diabetes Care. 2005; 28(2): 485-487.

Bergmans L, Snijdelaar DG, Katz J, et al.: Methadone for phantom limb pain. Clin J Pain. 2002; 18(3): 203-205.

Altier N, Dion D, Boulanger A, et al.: Management of chronic neuropathic pain with methadone: A review of 13 cases. Clin J Pain. 2005; 21(4): 364-369.

Altier N, Dion D, Boulanger A, et al.: Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: A case-study. Burns. 2001; 27(7): 771-775.

Makin MK, Ellershaw JE: Substitution of another opioid for morphine. Methadone can be used to manage neuropathic pain related to cancer. BMJ. 1998; 317(7150): 81.

Williams PI, Sarginson RE, Ratcliffe JM: Use of methadone in the morphine-tolerant burned paediatric patient. Br J Anaesth. 1998; 80(1): 92-95.

Sabatowski R, Kasper SM, Radbruch L: Patient-controlled analgesia with intravenous L-methadone in a child with cancer pain refractory to high-dose morphine. J Pain Symptom Manage. 2002; 23(1): 3-5.

Martinson IM, Nixon S, Geis D, et al.: Nursing care in childhood cancer: Methadone. Am J Nurs. 1982; 82(3): 432-435.

Miser AW, Miser JS: The use of oral methadone to control moderate to severe pain in children and young adults with malignancy. Clin J Pain. 1985; 1: 243-248.

Sirkia K, Hovi L, Pouttu J, et al.: Pain medication during terminal care of children with cancer. J Pain Symptom Manage. 1998; 15(4): 220-226.

Shir Y, Shenkman Z, Shavelson V, et al.: Oral methadone for the treatment of severe pain in hospitalized children: A report of five cases. Clin J Pain. 1998; 14(4): 350-353.

Lugo RA, MacLaren R, Cash J, et al.: Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU. Pharmacotherapy. 2001; 21(12): 1566-1573.

Meyer MM, Berens RJ: Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyltolerant pediatric intensive care unit patients. Pediatr Crit Care Med. 2001; 2(4): 329-333.

Robertson RC, Darsey E, Fortenberry JD, et al.: Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med. 2000; 1(2): 119-123.

Siddappa R, Fletcher JE, Heard AM, et al.: Methadone dosage for prevention of opioid withdrawal in children. Paediatr Anaesth. 2003; 13(9): 805-810.

Tobias JD, Deshpande JK, Gregory DF: Outpatient therapy of iatrogenic drug dependency following prolonged sedation in the pediatric intensive care unit. Intensive Care Med. Aug 1994; 20(7): 504-507.

Saroyan JM, Schechter WS, Tresgallo ME, et al.: Role of intraspinal analgesia in terminal pediatric malignancy. J Clin Oncol. 2005; 23(6): 1318-1321.

Merkel SI, Voepel-Lewis T, Shayevitz JR, et al.: The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997; 23(3): 293-297.

Hockenberry M, Wilson D: Wong’s Essentials of Pediatric Nursing. 8th ed. St. Louis: Mosby, 2009.

von Baeyer CL: Children’s self-reports of pain intensity: Scale selection, limitations and interpretation. Pain Res Manag. 2006; 11(3): 157-162.

Zernikow B, Michel E, Craig F, et al.: Pediatric palliative care: Use of opioids for the management of pain. Paediatr Drugs. 2009; 11(2): 129-151.



  • There are currently no refbacks.