Eficacia del uso de metadona oral en comparación con fentanilo transdérmico para el manejo del dolor en pacientes con cáncer terminal en cuidados paliativos: revisión sistemática

Abstract

Introduction: Adequate pain control is a fundamental priority to mitigate physical and emotional suffering in patients with terminal cancer within palliative care. In this context, oral methadone and transdermal fentanyl represent two common alternatives, each with distinct pharmacological properties. However, doubts remain as to which offers better results. Objective: To determine the efficacy of the use of oral methadone compared to transdermal fentanyl for pain management in patients with terminal cancer receiving palliative care. Methodology: A systematic review was conducted following the PRISMA 2020 guidelines. Articles published between 2019 and 2024 were selected from PubMed, Scopus, and Taylor & Francis databases. Nine studies were selected, seven of which were observational and two randomized. The risk of bias was analyzed using the GRADE PRO tool. Results: Oral methadone showed greater efficacy for pain control at lower doses and a lower incidence of adverse effects. Transdermal fentanyl achieved favorable analgesic efficacy at moderate doses, although it was associated with a higher frequency of somnolence and myoclonus. Discussion: Oral methadone demonstrated superiority, particularly in neuropathic or mixed pain. Fentanyl remains useful when the oral route is limited. The choice should be based on the clinical profile of each patient.