Pain control with Methadone and Ketamine in Morphine nonresponsive terminal cancer pain

Pain management remains one of the major challenges in the practice of palliative medicine.Approximately 80%-90%of pain due to cancer can be relieved relatively simply with oral analgesics and adjuvant drugs in accordance with the WHO guidelines.Nevertheless,there remains a small percentage of patients who experience severe pain despite rapid upward titration of opioid analgesics in their last days.Therefore,a comprehensive assessment and specialized management are needed in such cases.Methadone and ketamine in these cases with intractable neuropathic pain proved their efficacy.