Morphine Versus Methadone As First Line Strong Opioid for Cancer Pain
Status:
Terminated
Trial end date:
2015-01-01
Target enrollment:
Participant gender:
Summary
Primary Aims:
- To determine whether methadone used as first line strong opioid is superior to morphine
as evidenced by reduced pain over a 12-week treatment period in patients with advanced
cancer. Previous studies have demonstrated consistent improvement of pain control after
opioid rotation from morphine to methadone. In addition, the pilot study showed that
there was a trend towards lower pain intensity when methadone used as first line opioid
as compared to morphine. Researchers postulate that due to its superior analgesic
effects, methadone will result in better pain control over time as compared to morphine.
- To determine whether methadone used as first line strong opioid is superior to morphine
as evidenced by reduced frequency of neurotoxicity, dose escalation and treatment
failure over a 12-week treatment period. Previous studies have demonstrated that
patients develop increased pain or neurotoxicity after chronic use of morphine and
require frequent opioid escalation. Researchers postulate that methadone will
demonstrate lower opioid induced neurotoxicity, less frequent dose escalation and less
treatment failure over 12-week treatment period as compared to morphine.
Secondary Aim:
-To perform an economic evaluation, comparing the costs and clinical benefits of methadone
and morphine. Researchers will perform an evaluation that incorporates both treatment and
potential "downstream" costs, as well as an examination of clinical benefits that incorporate
preferences, to perform an appropriate economic comparison. We postulate that methadone and
its associated costs will be cheaper than morphine. However, if one strategy is both more
expensive and clinically superior than the other, researchers are prepared to perform an
incremental cost-effectiveness analysis. In that case, researchers expect to show that the
greater pharmaceutical costs involved with morphine will make its use not be a cost-effective
strategy.