Background Methadone is a synthetic opioid agonist, NMDA-receptor-channel blocker and pre-synaptic blocker of serotonin and noradrenaline re-uptake. It has been used in a variety of settings, including palliative care. It is considered in the Palliative Care Formulary (Sixth Edition) as an alternative if other opioids have been tried. Methadone has the benefit of being suitable in renal and hepatic impairment, but has a variable halflife and should be used with caution in those predisposed to QT prolongation. The PCF6 outlines differing strategies for methadone opioid conversion, but there are no current guidelines and a paucity of literature regarding the use of methadone as an adjunct.

Aim The aim of this study was to review the use of Methadone as an adjunct for pain control in Palliative Medicine.

Method A retrospective qualitative case series across two sites of Severn Hospice (Shrewsbury and Telford). System One (electronic recording system) has been used to ‘tag’ patients prescribed methadone between July 2017 and July 2018. This generated a list of six patients in which methadone had been prescribed as an adjunct. The medical notes were reviewed retrospectively and posthumously. We qualitatively judged the effectiveness of adjunct methadone in managing pain in each case. We then assessed for any trends apparent.

Results Qualitative description of analgesia in these patients demonstrates that methadone has been used in addition to other high tier pain relief (such as subcutaneous continuous infusion of Oxycodone and oral Morphine Sulfate) with good effect. Good stable pain control has been achieved. The team were able to titrate down doses of other forms of pain relief as the Methadone dose was increased.

Conclusions

• We believe methadone has a place in complex pain, especially that of a neuropathic nature.

• Prescribing Methadone as an adjunct appeared to reduce the requirements of other opioids.

• If used cautiously Methadone appears to mitigate against opioid toxicity.