{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T16:46:24Z","timestamp":1783788384019,"version":"3.55.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"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":["Palliative Medicine Reports"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The unique properties of methadone make it attractive for use in cancer pain. The use of very low initial doses of adjunctive methadone is a promising strategy given its simplicity and potentially reduced risk profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To understand if an ultralow-dose (ULD) methadone protocol (1\u2009mg by mouth daily initial dose with gradual titration) can improve pain control in outpatients with cancer-related pain not responsive to previous opioids and\/or nonopioid analgesics. We also sought to assess if the use of ULD methadone resulted in improvement in mood and sleep among other outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting\/Subjects:<\/jats:title>\n                    <jats:p>This study is a retrospective chart review of outpatients at the cancer pain clinic at the Tom Baker Cancer Centre in Calgary, Alberta, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>\n                      The mean ratings in maximum and average pain before methadone initiation, and at the final follow-up point are reported. Paired sample\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      tests evaluate for statistically significant differences in pain ratings before methadone initiation and at final follow-up. We also report the proportion of participants with a subjective improvement in pain, sleep, and mood (dichotomous \u201cyes\/no\u201d), and the mean number of weeks to initial documented pain improvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>68.6% of patients (24\/34) reported a subjective improvement in pain. Most patients reported improved sleep and mood (78.8% and 64.7%, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>More than two-thirds of patients reported an improvement in pain with a protocol using very low initial doses of adjunctive methadone. Our report is a preliminary retrospective chart review and larger prospective trials are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/pmr.2020.0034","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T11:23:38Z","timestamp":1595503418000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Ultralow-Dose Adjunctive Methadone with Slow Titration, Considering Long Half-Life, for Outpatients with Cancer-Related Pain"],"prefix":"10.1177","volume":"1","author":[{"given":"Srini","family":"Chary","sequence":"first","affiliation":[{"name":"Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amane","family":"Abdul-Razzak","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyle","family":"Galloway","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,7,23]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S1522-8649(07)50035-1","article-title":"The early history of methadone: Myths and facts","volume":"25","author":"Defalque RJ","year":"2001","unstructured":"Defalque RJ, , Wright AJ: The early history of methadone: Myths and facts. Bull Anesth Hist, 2001; 25:13\u201316.","journal-title":"Bull Anesth Hist"},{"key":"e_1_3_4_3_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1155\/2005\/286713","article-title":"A review of use of methadone for the treatment of chronic noncancer pain","volume":"10","author":"Lynch ME","unstructured":"Lynch ME: A review of use of methadone for the treatment of chronic noncancer pain. Pain Res Manag 2005;10:133\u2013144.","journal-title":"Pain Res Manag"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000507"},{"key":"e_1_3_4_5_2","first-page":"844","article-title":"Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement","volume":"63","author":"Mu A","year":"2017","unstructured":"Mu A, , Weinberg E, , Moulin DE, , Clarke H: Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician, 2017; 63:844\u2013852.","journal-title":"Can Fam Physician"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-015-0255-x"},{"key":"e_1_3_4_7_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1191\/096813098673619329","article-title":"The use of methadone in cancer pain poorly responsive to other opioids","volume":"5","author":"Morley JS","year":"1998","unstructured":"Morley JS, , Makin MK: The use of methadone in cancer pain poorly responsive to other opioids. Pain Reviews, 1998; 5:51\u201358.","journal-title":"Pain Reviews"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1320-8"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.11.2898"},{"key":"e_1_3_4_10_2","unstructured":"Kondejewski J: Methadone for Analgesia: KT Tools Project Literature Search and Review for Online Training Tool. Ottawa: Canadian Partnership Against Cancer pp. 46\u201347. http:\/\/www.virtualhospice.ca\/Assets\/Methadone%20Literature%20Review%202015_20151215095356.pdf (Last accessed June1 2019)."},{"key":"e_1_3_4_11_2","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.jpainsymman.2016.05.022","article-title":"Efficacy and safety of two methadone titration methods for the treatment of cancer-related pain: The EQUIMETH2 trial (methadone for cancer-related pain)","volume":"52","author":"Poulain P","unstructured":"Poulain P, , Berleur MP, , Lefki S, et al.: Efficacy and safety of two methadone titration methods for the treatment of cancer-related pain: The EQUIMETH2 trial (methadone for cancer-related pain). J Pain Symptom Manage 2016;52:626\u2013636.","journal-title":"J Pain Symptom Manage"},{"key":"e_1_3_4_12_2","first-page":"1","article-title":"Efficacy of low-dose and\/or adjuvant methadone in palliative medicine","author":"Chalker C","year":"2019","unstructured":"Chalker C, , O'Neill H, , Cranfield F: Efficacy of low-dose and\/or adjuvant methadone in palliative medicine. BMJ Support Palliat Care, 2019; 1\u20136.","journal-title":"BMJ Support Palliat Care"},{"key":"e_1_3_4_13_2","first-page":"1351","article-title":"Use of methadone as an adjunctive medication to low-dose opioids for neuropathic pain in the frail elderly: A case series","volume":"12","author":"Back TV","year":"2016","unstructured":"Back TV, , Pan J, , Kirstein A, et al.: Use of methadone as an adjunctive medication to low-dose opioids for neuropathic pain in the frail elderly: A case series. 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