Cancer pain control with a combination of methadone, amitriptyline, and non-narcotic analgesic therapy: A case series analysis

Fourteen patients referred to the Mount Sinai Medical Center Pain Management Service for control of severe, intractable cancer pain were evaluated for placement on a regimen consisting of methadone, amitriptyline, and a non-narcotic analgesic. All subjects had been previously treated with narcotic analgesics, either separately or in combination, without significant relief. Within 72 hours after initiation of combined therapy, 12 of the 14 patients who complied with the protocol reported being free of pain or experiencing only low-intensity residual discomfort. Good to excellent pain control was sustained in these patients, and no significant side effects were noted during follow-up periods of up to two months. We discuss here the analgesic benefits of methadone in combination with amitriptyline and non-narcotic analgesics for patients with refractory cancer pain.