Bruera, E., Miller, M.J., Macmillan, K., & Kuehn, N. (1992). Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain. Pain, 48(2), 163–166.

Study Purpose

This study was conducted to assess the effects of methylphenidate (MPH) on neuropsychological functions for patients with cancer on continuous subcutaneous (SQ) infusion of narcotics for pain.

Intervention Characteristics/Basic Study Process

Participants were assessed immediately before and two hours after dose for two days.

Sample Characteristics

  • The total number of participants was 20. Nineteen were used in data analyses.
  • The average participant age was 55 ± 12 years
  • 60% of participants were male and 40% were female. 
  • Participants had varied solid tumors, including lung, gastrointestinal, breast, prostate, and ovarian cancer.
  • Participants were required to have received narcotics for at least five days before admittance to the study.
  • No rescue doses were given to participants during the time frame of 7–10 am.

Setting

The study took place at Edmonton General Hospital in Alberta, Canada.

Study Design

The study was a randomized, double-blind, placebo-controlled, crossover trial.

Measurement Instruments/Methods

  • Finger Tapping Test for motor function
  • 20-item arithmetic test (5 questions each on addition, subtraction, multiplication, and division)
  • Reverse Memory of Digits—attention Visual memory (VM) for attention and visual memory
  • Subjective interview in which patients described which treatment helped more with confusion and sleepiness
  • Edmonton Staging System for Cancer Pain (Stage I, II, III) Visual Analogue Scale for pain, nausea, drowsiness, confusion, depression, and activity

Results

Significant improvement was noted in drowsiness, confusion, tapping speed, arithmetic skills, reverse digits, and visual memory (p < 0.001). Patients and investigators blindly chose MPH as more effective over the placebo in 13 of 14 cases.

Conclusions

In patients with cancer who had significant pain, immediate improvements in alertness, attention, and memory were noted. 

Limitations

  • The study had a small sample size.
  • There was no control group as a comparison.
  • No temporal level was provided of how long the MPH treatment would be beneficial.
  • The study displayed limited cognitive assessment and lack of follow-up.
  • The study was limited to patients on stable narcotic infusion.