Very-Low-Dose Methadone to Treat Refractory Neuropathic Pain in Children with Cancer

Background: Compared with nociceptive pain, neuropathic pain is a challenging diagnosis to make and successfully treat in children with cancer. Objective: The objective of this case report was to see whether very-low-dose methadone (VLDM) (defined as <50% of accepted starting analgesic dose of methadone for children) would be an effective strategy to treat refractory neuropathic pain due to vincristine in two children with acute lymphoblastic leukemia. Methods: This case report is based on the clinical experience and parent-reported outcomes of two children with refractory neuropathic pain who received VLDM. Results: Based on parent/caregiver-reported outcome scores over a one-year period, both children's refractory neuropathic pain syndrome was successfully treated with the addition of VLDM to their pre-existing regimen of gabapentin. Neither child suffered any adverse effects from methadone. Conclusions: VLDM shows promise as an effective, safe, and inexpensive way to treat refractory neuropathic pain in children with cancer.