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

J Palliat Med. 2017 Nov;20(11):1280-1283. doi: 10.1089/jpm.2017.0098. Epub 2017 Jun 13.


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.

Keywords: neuropathic pain; opioid; pain management; pediatrics.

Publication types

  • Case Reports

MeSH terms

  • Amines / therapeutic use*
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / therapeutic use*
  • Cancer Pain / drug therapy*
  • Child
  • Child, Preschool
  • Chronic Pain / drug therapy
  • Cyclohexanecarboxylic Acids / therapeutic use*
  • Drug Dosage Calculations
  • Gabapentin
  • Humans
  • Male
  • Methadone / therapeutic use*
  • Neuralgia / drug therapy*
  • Treatment Outcome
  • gamma-Aminobutyric Acid / therapeutic use*


  • Amines
  • Analgesics
  • Analgesics, Opioid
  • Cyclohexanecarboxylic Acids
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Methadone