Methadone Hydrochloride as First-Line Therapy in Treating Patients With Chronic Neuropathic Cancer Pain

Inclusion criteria

DISEASE CHARACTERISTICS: * Patients diagnosed with cancer and experiencing chronic neuropathic pain syndrome * Pain syndrome diagnosed by the investigator * Pain syndrome related to the effects of cancer or its treatment (i.e., chemotherapy, radiotherapy, and surgery) * Meets 1 of the following criteria: * Need to be started on strong opioids * Require an increase in opioid dose and are currently taking ≤ 75 mg of total daily dose of oral morphine equivalent * Experiencing pain for ≥ 4 weeks with an average pain score of ≥ 4 or a worst pain score of ≥ 5 (using the 0-10 Brief Pain Inventory Scale) during the past 24 hours * Requires strong opioids to control pain and is using an oral morphine-equivalent dose of 0-75 mg per day, on average, including breakthrough analgesia, within the past 3 full calendar days * Mixed pain syndrome allowed provided the neuropathic component is the predominant pain * Meets 1 of the following criteria: * Receiving concurrent chemotherapy but the chronic neuropathic pain is not related to this treatment and is not expected to improve or worsen because of this therapy * Received prior chemotherapy but discontinued treatment, has not received chemotherapy within the past 7 days, and no further chemotherapy is planned * No prior chemotherapy PATIENT CHARACTERISTICS: * Karnofsky performance status 40-100% * ALT and AST ≤ 3 times upper limit of normal (ULN) * Creatinine ≤ 2 times ULN * No other known laboratory abnormality that, in the investigator's opinion, would contraindicate study participation * Not pregnant or nursing * Fertile patients must use effective contraception * Mini-Mental State Examination score ≥ 25/30 * Able to speak, read, and write in either English or French * Willing to complete study diary and questionnaires * Available for study treatment and follow up (i.e., within reasonable geographical limits of the participating center) * Able to swallow and tolerate oral medications * Patients with prior exposure to methadone hydrochloride must be able to tolerate it * No intractable nausea and vomiting * No presence or history of unstable disease or condition that would, in the investigator's opinion, preclude patient participation in study treatment, such as: * Head injury * Increased intracranial pressure * Uncontrolled seizures * Uncontrolled asthma * Decompensated chronic obstructive pulmonary disease * Untreated prostate hypertrophy * Acute abdominal conditions * Untreated hyperthyroidism and Addison disease * Increased cerebrospinal fluid pressure * Urethral stricture * Severe cardiac arrhythmias (especially prolonged QT interval) * Symptomatic hypotension * Toxic psychosis * Cor pulmonale * Sleep apnea * Severe obesity * Kyphoscoliosis * Myxedema * Central nervous system depression * Coma * No history of significant alcohol, analgesic, or narcotic substance abuse within the past 6 months * Able physically and mentally to answer questions and comply with study treatment * No patient who lives alone and cannot access at least 1 caregiver who can monitor on a daily basis at home PRIOR CONCURRENT THERAPY: * See Disease Characteristics * More than 3 weeks since prior radiopharmaceutical treatment or radiotherapy * Concurrent co-analgesics and medications that can affect methadone hydrochloride metabolism allowed provided patients have been on a stable dose for the past 3-5 days and ≥ 5 half lives have passed since any change in dose * Not scheduled to start chemotherapy during the study treatment * Not planning on starting or discontinuing medication associated with modified methadone hydrochloride clearance during study treatment * No concurrent therapeutic procedure that is likely to influence pain intensity during the study period * No concurrent other opioid medications * No other concurrent methadone hydrochloride