A case of returning to work by switching from methadone to another opioid

Abstract

Methadone is a highly effective opioid prescribed for severe cancer pain patients. However, opioid switching may be required because of side effects or poor pain control. We experienced a case of 56-year-old woman with retro-longitudinal primary malignant soft tissue sarcoma. She had received methadone 30 mg/day for refractory metastatic neuropathic pain of upper thoracic vertebras and nerves, but she had not obtained sufficient pain relief, suffering from side effects of nausea, drowsiness and malaise. Radiation therapy for thoracic vertebral lesions were started, considering switching from methadone to other opioids. We performed opioid switching by 2 steps of methadone reduction (each 15 mg) simultaneously with oxycodone replacement (90 mg) over 2 weeks. We successfully switched from methadone to oxycodone with combination of radiation therapy and other pharmacotherapy, and finally she could return to work.