{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:00:15Z","timestamp":1790074815660,"version":"4.0.1"},"reference-count":17,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2006,4,13]],"date-time":"2006-04-13T00:00:00Z","timestamp":1144886400000},"content-version":"unspecified","delay-in-days":133,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2005,12]]},"abstract":"<jats:p><jats:italic>Objective:<\/jats:italic> This prospective study documents the use of \nmethadone as part of an opioid rotation strategy in patients with \nuncontrolled pain and severe delirium admitted for terminal care to a \ntertiary cancer palliative care hospital.<\/jats:p><jats:p><jats:italic>Methods:<\/jats:italic> We reviewed the treatment of 20 patients with severe \npain and delirium at the end of life who's delirium did not improve \n24 h or longer after starting a neuroleptic medication.<\/jats:p><jats:p><jats:italic>Results:<\/jats:italic> Ten male and 10 female patients, 47 to 77 years old, \nwere rotated or \u201cswitched\u201d to methadone due to uncontrolled \npain in the setting of delirium, limiting further opioid dose escalation. \nAt 2 weeks, a total of 10 patients had expired. Of the 10 patients who \nwere alive 2 weeks after starting methadone, 7 patients were stable on an \naverage of 1.1 mg\/h methadone, 2 patients were restarted on morphine \nIV and one on Percocet. The calculated average equianalgesic dose of \nmethadone was 9% (2%\u201317%) of the previous morphine-equivalent dose. \nOf the 20 patients who were switched to methadone for what appeared to be \nterminal delirium, the pain control was significant in 15, moderate in 3, \nand unchanged in 2 patients. Average analgesia was good to excellent \n(average Numeric Analog Scale rating [NAS] decreased from 8.2 to \n2.5). Sedation had decreased from 1.65 to 0.55 on a scale of 0 to 3. Of \nthe 20 patients, improvement of cognitive status was significant in 9, \nmoderate in 6, partial in 2, and none in 3 patients. The Memorial Delirium \nAssessment Scale (MDAS) showed improvement from an average of 23.6 prior \nto the switch to 10.6 3 days after. Decreased alertness on methadone was \ndevoid of agitated features.<\/jats:p><jats:p><jats:italic>Significance of results:<\/jats:italic> Our study suggests that methadone \ncan be effective in the treatment of both refractory pain and what appears \nto be terminal delirium. Most patients in our group had at least a \nshort-term improvement in mental status as well as significant and lasting \nimprovement in analgesia.<\/jats:p>","DOI":"10.1017\/s1478951505050479","type":"journal-article","created":{"date-parts":[[2008,4,21]],"date-time":"2008-04-21T15:28:32Z","timestamp":1208791712000},"page":"311-317","source":"Crossref","is-referenced-by-count":41,"title":["Methadone in the treatment of pain and terminal delirum in advanced \ncancer patients"],"prefix":"10.1017","volume":"3","author":[{"given":"NATALIE","family":"MORYL","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MARIA","family":"KOGAN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHRISTOPHER","family":"COMFORT","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EUGENIE","family":"OBBENS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2006,4,13]]},"reference":[{"key":"S1478951505050479_ref016","doi-asserted-by":"crossref","unstructured":"Tucker, G.J. (1991). DSM-IV: Proposals for revision of diagnostic criteria fordelirium.International Psychogeriatrics,3,197\u2013208.","DOI":"10.1017\/S1041610291000662"},{"key":"S1478951505050479_ref017","doi-asserted-by":"crossref","unstructured":"Yennurajalingam, S. , Braiteh, F. , & Bruera, E. (2005).Pain and terminal delirium research in the elderly.Clinical Geriatric Medicine,21,93\u2013119.","DOI":"10.1016\/j.cger.2004.09.002"},{"key":"S1478951505050479_ref006","doi-asserted-by":"crossref","unstructured":"Foley, K.M. & Houde, R.W. (1998).Methadone in cancer pain management: Individualized dose and titrateto effect.Journal of Clinical Oncology,16,3213\u20133215.","DOI":"10.1200\/JCO.1998.16.10.3213"},{"key":"S1478951505050479_ref013","doi-asserted-by":"crossref","unstructured":"Mercadante, S. , Casuccio, A. , Fulfaro, F. ,et al.(2001).Switching from morphine to methadone to improve analgesia andtolerability in cancer patients: A prospective study.Journal of Clinical Oncology,19,2898\u20132904.","DOI":"10.1200\/JCO.2001.19.11.2898"},{"key":"S1478951505050479_ref010","doi-asserted-by":"crossref","unstructured":"Lawlor, P.G. , Turner, K.S. , Hanson, J. ,et al.(1998).Dose ratio between morphine and methadone in patients with cancerpain: A retrospective study.Cancer,82,1167\u20131173.","DOI":"10.1002\/(SICI)1097-0142(19980315)82:6<1167::AID-CNCR23>3.0.CO;2-3"},{"key":"S1478951505050479_ref015","doi-asserted-by":"crossref","unstructured":"Santiago-Palma, J. , Khojainova, N. , Kornick, C. , Fischberg, D.J. , Primavera, L.H. , Payne, R. , & Manfredi, P. (2001).Intravenous methadone in the management of chronic cancer pain: Safeand effective starting doses when substituting methadone forfentangl.Cancer,92,1919\u20131925.","DOI":"10.1002\/1097-0142(20011001)92:7<1919::AID-CNCR1710>3.0.CO;2-G"},{"key":"S1478951505050479_ref011","doi-asserted-by":"crossref","unstructured":"Manfredi, P.L. , Borsook, D. , Chandler, S.W. , & Payne, R. (1997).Intravenous methadone for cancer pain unrelieved by morphine andhydromorphone: Clinical Observations.Pain,70,99\u2013101.","DOI":"10.1016\/S0304-3959(96)03313-1"},{"key":"S1478951505050479_ref012","doi-asserted-by":"crossref","unstructured":"Mercadante, S. 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(1993).Methadone in the management of cancer pain: A review.Pain,52,137\u2013147.","DOI":"10.1016\/0304-3959(93)90125-9"},{"key":"S1478951505050479_ref008","doi-asserted-by":"crossref","unstructured":"Khojainova, N. , Santiago-Palma, J. , Kornick, C. ,et al.(2002).Olanzapine in the management of cancer pain.Journal of Pain and Symptom Management,23,346\u2013350.","DOI":"10.1016\/S0885-3924(02)00378-0"},{"key":"S1478951505050479_ref004","unstructured":"Estfan, B. , LeGrand, S.B. , Walsh, D. ,et al.(2005).Opioid rotation in cancer patients: Pros and cons.Oncology,19,511\u2013516;discussion 516\u2013518, 521\u2013523, 527\u2013528."},{"key":"S1478951505050479_ref002","doi-asserted-by":"crossref","unstructured":"Breitbart, W. & Strout, D. (2000).Delirium in the terminally ill.Clinical Geriatric Medicine,16,357\u2013372.","DOI":"10.1016\/S0749-0690(05)70061-6"},{"key":"S1478951505050479_ref014","doi-asserted-by":"crossref","unstructured":"Portenoy, R.K. & Lesage, P. 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