LAUSR

score of 5 in the visual analogue scale [VAS] rising to 10 during exacerbations, to a baseline VAS score of 1 and no exacerbations) accompanied by mild itching. The patient was managed with a multidisciplinary approach (nasogastric tube feeding, social support, normalisation of wake--sleep cycles, behavioural psychotherapy, . . .) which he received well. At present, 6 months after the switch, the patient maintains the initial response, has discontinued the use of topical lidocaine and anxiolytic treatment, is pain-free and has a normal lifestyle (goes out with friends, attends school, is recovering his appetite, . . .), with no signs of toxicity or side effects (normal ECG). Despite having observed a single case, we can assert that the switch to oral methadone for the management of difficult-to-control non-cancer NP in children is a therapeutic option that should be contemplated if it can be delivered by experienced professionals and under strict in-hospital supervision.