Table 2.

Stepped titration method

Patient number	1	2	3	4	5	6
Patient demographics	41 years/male	48 years/male	47 years/male	22 years/female	39 years/female	42 years/female
Presenting symptoms	Pain chest back, pelvis	Pain Right shoulder and upper limb	Pain Right thigh radiating to limbs	Pain lower back radiating to bilateral limbs	Pain chest	Pain lower back radiating to left lower limb
Primary cancer	Ca lung	Ca lung	Leiomyosarcoma right thigh	Metastatic ewings sarcoma	Metastatic chondrosarcoma	Ca rectum
NRS on presentation	10/10	6/10	7/10	10/10	8/10	10/10
OMDD	360 mg oral morphine	90 mg oral morphine	240 mg oral morphine	240 mg oral morphine	120 mg oral morphine	360 mg oral morphine
Converted methadone dose	(12:1) 30 mg oral methadone	(4:1) 22.5 mg oral methadone	(8:1) 30 mg oral methadone	(8:1) 30 mg oral methadone	(8:1) 15 mg oral methadone	(12:1) 30 mg oral methadone
Methadone dose given to patient after ~30 % reduction	22.5 mg	15 mg	22.5 mg	22.5 mg	12.5 mg	22.5 mg
NRS at discharge	2/10	3/10	3/10	2/10	2/10	The patient discontinued methadone due to severe intractable pain.
Satisfaction level on morphine	3/10	6/10	5/10	4/10	1/10
Satisfaction level on methadone	9/10	8/10	6/10	8/10	9/10	Satisfaction level with morphine was 3/10 and that with methadone was 2/10. Later on patient was given a trial of intrathecal morphine which showed excellent results. So, she was considered for intrathecal implant and was planned for the same. At present patient is having a NRS-2/10 on intrathecal implant with morphine
Current status	Continuing on the same oral dose of methadone since last 2 months	Methadone dose was increased to 22.5 mg over next two weeks. Now continuing with same dose since 2.5 months	Methadone dose was increased to 30 mg over next week. Now continuing with same dose for 2.5 months	Continuing on the same oral dose of methadone for last 2 months	Continuing on the same oral dose of methadone since last 2 months

NRS: Numerical Rating Scale, CT: Computed tomography, OMDD: Oral morphine daily dose