{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:02:56Z","timestamp":1784257376946,"version":"3.55.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The initiation of methadone, a known effective analgesic for cancer pain, is complex. The existing protocols are often inadequately described; therefore, a classification of literature is needed. We reviewed and classified the recent literature on methadone initiation protocols in cancer patients experiencing severe pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To provide a new classification of initiation protocols, based on a critical literature review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>\n                      The MEDLINE database was searched for articles published until March 25, 2021, using the terms \u201ccancer pain,\u201d \u201cmethadone,\u201d \u201cmethadone introduction,\u201d or \u201cmethadone initiation.\u201d The search was limited to human studies, randomized controlled trials (RCTs), other clinical trials, meta-analyses, and case reports. Selected articles were assessed for initiation details (rapid or progressive), administered dose (fixed rescue dose or\n                      <jats:italic toggle=\"yes\">ad libitum<\/jats:italic>\n                      ), and dose calculation (fixed or progressive ratios using morphine equivalent daily dose [MEDD] for daily or unitary dose).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-four publications that met our inclusion criteria were analyzed. No large-scale prospective double-blind RCTs with robust design were identified. Most studies assessed relatively small numbers of patients. Eight initiation types were identified, of which three involved seven \u201chigh quality\u201d studies: \u201crapid switch\u2014fixed doses and rescue dose\u2014progressive daily ratio,\u201d \u201cprogressive switch\u2014fixed dose and rescue dose\u2014progressive daily ratio,\u201d and \u201crapid switch\u2014\n                      <jats:italic toggle=\"yes\">ad libitum<\/jats:italic>\n                      \u2014fixed ratio for unitary dose\u201d protocols. This classification provides the latest information on methadone initiation protocols. The total daily dose of methadone varied largely across protocols.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      We recommend a maximal daily methadone dose of 100\u2009mg (3 doses of 30\u2009mg or 5 doses of 20\u2009mg) for MEDD &lt;500\u2009mg, when the two \u201c\n                      <jats:italic toggle=\"yes\">ad libitum<\/jats:italic>\n                      \u201d protocols are used. Further clinical research on this topic is warranted.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2021.0309","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T09:48:20Z","timestamp":1638352100000},"page":"1884-1894","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Methadone Switching for Cancer Pain: A New Classification of Initiation Protocols, Based on a Critical Literature Review"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-3401","authenticated-orcid":false,"given":"Erwan","family":"Treillet","sequence":"first","affiliation":[{"name":"Pain Unit, Colmar Civil Hospital, Colmar, France."},{"name":"Palliative Care Mobile Unit, Sant\u00e9 Centre Alsace, Colmar, France."},{"name":"Pain Unit, APHP Lariboisiere Hospital, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Giet","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, Colmar Civil Hospital, Colmar, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Picard","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, Hopital Diaconnesse Croix Saint Simon, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Laurent","sequence":"additional","affiliation":[{"name":"Pain Unit, Gustave Roussy Institute, Villejuif, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"Serresse","sequence":"additional","affiliation":[{"name":"Palliative Care Mobile Unit, APHP Pitie Salpetriere Hospital, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.douler.2019.03.002","article-title":"La douleur du cancer, d'hier \u00e0 aujourd'hui\u2026elle persiste! 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