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Opioid switching from oral slow release morphine to oral methadone may improve pain control in chronic non-malignant pain: a nine-month follow-up study

Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, olavmagn{at}frisurf.no

Stein Kaasa

Pain and Palliation Research Group, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and Palliative Medicine Unit, Department of Oncology, St. Olav University Hospital, Trondheim

Ola Dale

Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology and Department of Anaesthesia, St. Olav University Hospital, Trondheim

Pål Klepstad

Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology and Department of Anaesthesia, St. Olav University Hospital, Trondheim

Nils Inge Landrø

Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim and Department of Psychology, University of Oslo, Oslo

Petter C Borchgrevink

Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology and Multidisciplinary Pain Centre, Department of Anaesthesia, St. Olav University Hospital, Trondheim

Twelve patients with poor pain control or unacceptable side effects during treatment with morphine were switched to methadone and followed for nine months in this open prospective study. Primary outcomes were patient preference for opioid and pain control while physical, cognitive and role functioning were secondary outcomes. The morphine dose was decreased by 1/3 daily and was replaced with an equianalgesic dose of methadone over a three-day period. During switching and a one-week dose titration period, patients were given additional methadone if required. During dose titration one patient experienced sedation requiring naloxone. Four patients were switched back to morphine due to poor pain control, drowsiness or sweating. Seven patients preferred long-term (>nine months) treatment with methadone and reported reduced pain and improved functioning while cognition was not improved. This study brings novel information on the long-term consequences for pain control, health-related quality of life and cognitive functioning with a switch from morphine to methadone in the treatment of chronic non-malignant pain.

Key Words: chronic pain • methadone • neuropsychology • opioid switch • quality of life

Palliative Medicine, Vol. 20, No. 1, 35-41 (2006)
DOI: 10.1191/0269216306pm1099oa


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