Prevalence and pharmacological treatment of pain in patients with cancer: The role of opioids with and without NMDA receptor affinity

This thesis describes the problem of pain in patients with cancer. In the years 2005-2014 the prevalence of pain in cancer patients was no different than in the four decades before. The hypothesis that optimal treatment of pain can be improved by better treating the type of pain is explored. This thesis shows that patients with pain caused by cancer in the head-neck region respond better to methadone as compared to fentanyl when they suffer from a neuropathic pain component. When there is pure nociceptive pain the treatment of methadone is not inferior to treatment with fentanyl. A predictive model including neuropathic pain, age, duration of pain and treatment with methadone is able to predict the chance of clinical successful painreduction after one week of opioid treatment.