Table 3.

Rapid titration method

Patient number	7	8	9	10
Patient demographics	69 years/male	47 years/female	40 years/male	40 years/male
Presenting symptoms	Pain right side of the face radiating to the ear and neck	Pain lower back and abdomen	Pain lower back and radiating to bilateral limbs	Pain perineal region
Primary cancer	Ca right tonsil	Ca cervix	STS thigh with skeletal metastasis	Ca anal canal
NRS on presentation	10/10	8/10	9/10	8/10
OMDD	180 mg	300 mg	180 mg	240 mg
Converted methadone dose	(8:1) 22.5 mg oral methadone	(12:1) 25 mg oral methadone	(8:1) 22.5 mg oral methadone	(8:1) 30 mg oral methadone
Methadone dose given to patient after ~30 % reduction	15 mg	22.5 mg	15 mg	22.5 mg
NRS at discharge	2/10	1/10	2/10	NRS decreased to 5/10 after 2 days.
Satisfaction level on morphine	5/10	3/10	2/10	After discussion of CT scans, the patient was found to be an ideal candidate for ganglion impar block.
Satisfaction level on methadone	8/10	9/10	8/10
Current status	Methadone dose was increased to 22.5 mg over next 2 weeks Now continuing with same dose for 2.5 months	Continuing on same oral dose of methadone for last 2.5 months	Continuing on same oral dose of methadone for last 2.5 months	The patient was given ganglion impar block which was successful. Methadone was again titrated on 120 mg OMDD. At present, the patient is having pain relief on 10 mg oral methadone per day for 2 months

NRS: Numerical rating scale, CT: Computed tomography, OMDD: Oral morphine daily dose, STS: Soft tissue sarcoma