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Treatment of Pain in Head-and-Neck Cancer Patients: is Methadone More Effective?

Information source: Maastricht University Medical Center
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Pain; Cancer of Head and Neck

Intervention: fentanyl (Drug); methadone (Drug)

Phase: Phase 4

Status: Completed

Sponsored by: Maastricht University Medical Center

Official(s) and/or principal investigator(s):
Maarten van Kleef, MD, PhD, Study Chair, Affiliation: Maastricht University Medical Center

Summary

Background of the study: Treatment of Pain in Head-and-Neck Cancer Patients: is methadone more effective than fentanyl? Pain is a prevalent symptom in patients with cancer. A neuropathic component is seen in one third of the patients. In patients with head-and-neck cancer neuropathic pain is far more prevalent than in a general cancer population: 46-64%. Treatment of neuropathic pain is complex and available treatment modalities achieve (partial) pain relief in only 40-60% of patients. The N-Methyl-D-Aspartate Receptor (NMDAR) plays a central role in the mediation of neuropathic pain. NMDAR blockers could be a new approach to treat neuropathic pain in patients with cancer. Methadone is a strong opioid but at the same time significant non-competitive NMDA-receptor antagonist qualities have been described. Many small studies and case-reports describe the successful rotation from different strong opioids to methadone. There are no studies that selected patients with (predominantly) neuropathic pain to be treated with methadone, whereas this group of patients is expected to profit from the NMDAR-antagonist properties of methadone. Objective of the study: This randomised controlled trial (RCT) aims to investigate whether addition of a NMDAR-antagonist to a strong opioid (methadone) is superior in the treatment of predominantly neuropathic pain over a strong opioid alone (fentanyl) in terms of pain relief and time to achieve significant pain relief. Study design: Open label randomised controlled trial Study population: opioid naïve patients with histological proven head-and-neck cancer and (partly) neuropathic pain with a NRS score of ≥ 4, age =/> 18 years Intervention Treatment with methadone or fentanyl patch Primary study parameters/outcome of the study: Is methadone more effective than fentanyl in the treatment of pain in patients with head-and-neck cancer with respect to 1. significant pain relief (reduction of Numeric Rating Scale (NRS) of 50%) and 2. pain interference Secondary study parameters/outcome of the study: Is methadone superior to fentanyl in the treatment of pain in patients with head-and-neck cancer with respect to 1. time to achieve significant pain relief 2. side-effect profile?

Clinical Details

Official title: Treatment of Pain in Head-and-Neck Cancer Patients: is Methadone More Effective Than Fentanyl?

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: significant pain relief (reduction of Numeric Rating Scale (NRS) of 50%)

Secondary outcome:

time to achieve significant pain relief

side-effect profile

Detailed description: Study design The duration of the study will be 9 weeks. Patients will visit the outpatient clinic 5 times. Patients of MAASTRO clinic will be seen directly before or after the radiation therapy. No extra visits will be necessary.

T= - 1: - informed consent

- sort of pain (DN4)

- randomisation

T = 0 - questionnaire 1: demographic variables, disease specific variables, BPI, side effect

questions, HADS, QoL

- explain and provide the pain sheet

- start methadone 2 x 2,5 mg or fentanyl patch 12 μg/uur

- breakthrough medication: 50 µg fentanyl nose spray or fentanyl stick 400 µg till 6x/day

T=1 - questionnaire 2: BPI, side effect questions, global perceived effect

1 week - review pain sheet on pain and total rescue doses

- if necessary increase dose strong opioid with 50%

T=2 - questionnaire 2: BPI, side effect questions, global perceived effect 3 weeks - review

pain sheet on pain and total rescue doses

- if necessary increase dose strong opioid with 50%

- if necessary decrease dose strong opioid with 30%

T=3 - questionnaire 2: BPI, side effect questions, global perceived effect 5 weeks - review

pain sheet on pain and total rescue doses

- if necessary increase dose strong opioid with 50%

- if necessary decrease dose strong opioid with 30%

T = 4 - questionnaire 3: BPI, side effect questions, global perceived effect, QoL

- if necessary increase dose strong opioid with 50%

- if necessary decrease dose strong opioid with 30%

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- opioid naive patients with histological proven head-and-neck cancer and (partly)

neuropathic pain with a NRS score of =/> 4 Exclusion Criteria:

- age under 18

- not being able to read or fill in the questionnaires

- recent operation (less than 7 days)

- women of childbearing potential not using contraception

Locations and Contacts

University Hospital Maastricht, Maastricht 6202AZ, Netherlands
Additional Information

Starting date: May 2011
Last updated: July 15, 2015

Page last updated: August 23, 2015

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