The Use of Very-Low-Dose Methadone and Haloperidol for Pain Control in the Hospital Setting: A Preliminary Report

Objective: Our aim was to evaluate the use of very-low-dose methadone with haloperidol in the acute-care setting. Methods: We reviewed the records of 735 hospitalized patients receiving a palliative care consultation between 2011 and 2014. All patients with pain on opiates were offered conversion to methadone, 2.5mg/day to 15mg/day, in conjunction with scheduled haloperidol. Additional doses of haloperidol or short-Acting opiates were given as needed for pain. Patients receiving an opiate at a morphine-equivalent daily dose (MEDD) of ≥40mg had pain scores assessed daily, before and after conversion. Descriptive statistics were used to summarize the results. Results: Forty-three patients underwent conversion from another opiate (median MEDD, 78.5mg) to methadone (median daily dose, 5mg) and haloperidol (median daily dose, 1.5mg). The median pain score was 5 in the week prior to conversion, 1 in week 1 after conversion (p<0.001 for difference), and zero in week 2. Similar results were seen for patients with cancer and noncancer diagnoses and for those with the highest and lowest initial opiate doses. Conclusion: The use of very-low-dose methadone in conjunction with haloperidol in the acute-care setting resulted in improved pain control after conversion from typical opiates.