TITULACIÓN DE OPIODES PARA EL MANEJO DEL DOLOR POR CÁNCER EN CUIDADOS PALIATIVOS

DRAN GRACIELA

SALTA

Congreso; X CONGRESO NACIONAL DE MEDICINA Y CUIDADOS PALIATIVOS; 2019

AAMYCP

Background Methadone is a low-cost, strong opioid that is increasingly used as a first-line treatment for pain in palliative care(PC). Its long and unpredictable half-life and slow elimination phase can make titration challenging. Evidence for titrationmodalities is scarce.Objective To describe the titration phase of the treatment with low-dose first-line methadone and the use of methadone forbreakthrough pain.Methods Prospective study with strong opioid?naïve patients with moderate to severe cancer pain followed at a tertiary PC unitin Argentina. Starting methadone dose was 2.5?5 mg/day every 8, 12, or 24 h. Titration allowed daily dose increases from day 1,and prescription of oral methadone 2.5 mg every 2 h with a maximum of 3 rescue doses/day for breakthrough pain. Pain control,methadone stabilization dose, and adverse effects, among other variables, were daily assessed over the first 7 days (T0?T7).Results Sixty-two patients were included. Initial median (IQR) methadone dose was 5 (2.5) mg/day. Pain intensity decreasedfrom a median (IQR) of 8 (2.3) at T0 to 4 (2.3) at T1 and remained ≤ 4 until T7 (all p < 0.0001 compared to T0). Similar resultswere obtained through the categorical and tolerability scales for pain. Fifty patients (81%) reached pain control, 66% in the first48 h. Methadone daily doses at T2 and T7 were higher than that at T0: 7.5 (3) and 6.7 (5.5) versus 5 (2.5), respectively (all p