Use of sublingual methadone for treating pain of chemotherapy-induced oral mucositis

Anita Gupta, DO, PharmD; Benjamin Duckles, MD; James Giordano, MPhil, PhD

doi:10.5055/jom.2010.0007

Authors

Anita Gupta, DO, PharmD
Benjamin Duckles, MD
James Giordano, MPhil, PhD

DOI:

https://doi.org/10.5055/jom.2010.0007

Keywords:

mucositis, methodone, sublingual, esophageal, cancer

Abstract

Chemotherapy-induced and radiation-induced mucositis is a debilitating and often painful condition resulting in an inability to swallow, and thus inability to maintain adequate quality of life and overall functioning. To date, attempts on palliation of mucositis-related pain have primarily used topical anesthetic solutions and intravenous opioids; these approaches have achieved only limited success, particularly in oncology patients. The authors present a novel case of mucositis-related pain that is effectively treated with sublingual methadone. Sublingual methadone is an alternative to standard treatment options for mucositis-related pain and has unique pharmacokinetic and pharmacodynamic properties that make methadone a suitable agent for this pathology. These properties are addressed and discussed, as is the need for additional study to better understand the potential benefits, burdens, and risks that may be associated with this formulation of methadone when treating chemotherapy-induced and/or radiation therapy-induced mucositis in patients with cancer.

Author Biographies

Anita Gupta, DO, PharmD

Assistant Professor, Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Benjamin Duckles, MD

Resident, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.

James Giordano, MPhil, PhD

Professor of Neuroscience, Philosophy, and Ethics, Centre for Philosophical Psychology; Fellow, Blackfriars Hall, University of Oxford, Oxford, United Kingdom; Director, Center for Neurotechnology Studies, Potomac Institute for Policy Studies, Arlington, Virginia.

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