The use of opioid analgesics in chronic pain therapy — a retrospective, single-center study (original) (raw)
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Opioids in cancer and chronic non-cancer pain therapy - indications and controversies
Acta Anaesthesiologica Scandinavica, 2001
Indications for strong opioids for cancer-related pain as well as for chronic non-cancer pain are that non-opioid drugs, and other less risky therapies, fail and that the pain is opioid-sensitive. The WHO analgesic ladder principle continues to serve as an excellent educational tool in the efforts by WHO in collaboration with the World Federation of Societies of Anaesthesiologists (WFSA) and The International Association for the Study of Pain (IASP) to increase knowledge of pharmacological pain therapy and increase availability of essential opioid analgesics worldwide. Opioids differ in pharmacodynamics and pharmacokinetics, and patients have different pharmacogenetics and pain mechanisms. Sequential trials of the increasing numbers of available opioid drugs are therefore appropriate when oral morphine fails. Controversies continue concerning diagnosis and handling of opioid-insensitive pain in cancer and chronic non-cancer pain, opioid-induced neurotoxicities, risks of tolerance, addiction, pseudo-addiction, and methods for improving effectiveness and C ANCER patients may be in an acute, curative-therapy phase, in remission, tumour free, apparently cured but with severe pain as complications of antitumour therapy. In any of these phases they may suffer from acute and chronic somatic and visceral pain, which may be nociceptive, inflammatory, and neuropathic pain. Neuropathic pain is caused by the tumour directly impinging on, or infiltrating nervous tissue. Treatment-induced neuropathic pain is especially problematic as it may persist in patients apparently cured of their cancer. This comprises neuropathic pain from surgical damage of nervous tissue, scar after surgery or irradiation encroaching upon nerves, and neurotoxic effects of radiotherapy and chemotherapy (1). Bone metastases near joints and skeletal muscles cause incident pain from movement. Breakthrough pain can arise in visceral organs related to smooth muscle contractions or tumour emboli and ischaemic, infarction pain. Opioids alone, or co-administered with non-opioid analgesics and adjuvant drugs, can relieve pain caused by cancer in a majority of patients (1, 2). Indi-1059 decreasing adverse effects of long-term opioid therapy, treating breakthrough pain with immediate release oral and transmucosal opioids. Consensus guidelines have recently been developed in the Nordic countries concerning the ethical practice of palliative sedation when opioids and other pain-relieving therapies fail in patients soon to die. Guidelines for long-term treatment with strong opioids of chronic non-cancer-related pain are also being developed in the Nordic countries, where very diverging traditions for the usage of such therapy still exist.
Cancer-Related Pain Management and the Optimal Use of Opioids
Acta médica portuguesa
Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics â by a registered medical practitioner for absolute pain control â is a legitimate practice. In this article we look at patientsâ fears and physiciansâ generalhesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.
The lancet oncology, 2012
Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and consensus recommendations were created by formal international expert panel. The content of the guidelines was defined according to several topics, each of which was assigned to collaborators who developed systematic literature reviews with a common methodology. The recommendations were developed by a writing committee that combined the evidence derived from the systematic reviews with the panellists' evaluations in a co-authored process, and were endorsed by the EAPC Board of Directors. The guidelines are presented as a list of 16 evidence-based recommendations developed according to the Grading of Recommendations Assessment, Development...
Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer
Nature Reviews Clinical Oncology, 2018
Pain is one of the most frequent and distressing symptoms in patients diagnosed with cancer. It might be short term as a result of invasive procedures, surgery, radiation therapy or chemotherapy, or it might be chronic (Table 1). Clinical evidence supports the use of opioid analgesics as the gold standard in cancer-related pain 1 , but their benefits must be carefully balanced against potential complications. Some patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, which can result in untoward adverse effects, accidental overdose or even death of the patient or others. Over the years, this issue has become increasingly concerning, culminating in an opioid overdose epidemic in the USA and other countries that has left the medical community, government agencies and other stakeholders grappling with ways to address it 2. Contrary to previous perceptions, emerging data suggest that patients with cancer are also at risk of NMOU 3,4. In this Review, we examine the role of opioids in managing cancer-related pain, the risk of NMOU and substance use disorder (SUD) and methods to achieve the right balance between the two in order to ensure safe opioid use. Opioids for cancer-related pain Opioids produce analgesia by binding to opioid receptors along the nociceptive pathway to reduce transmission of the impulses and perception of pain at the somatosensory cortex. Some pain syndromes 5,6 (Table 1) might be controlled appropriately with non-opioids, such as NSAIDs and acetaminophen and/or adjuvant analgesics (medications that are mainly indicated for conditions other than pain, such as seizure and depression, but that can also have analgesic effects when used alone or in combination with other analgesics) 1. When pain is persistent and refractory to these measures, opioids are usually necessary. Opioids include morphine, oxycodone, hydrocodone, tramadol, hydromorphone, oxymorphone, fentanyl, buprenorphine and methadone. Morphine is considered the prototype opioid analgesic and the first drug of choice in cancer-related pain, mostly because it is relatively more common, available and accessible-but not necessarily more effectivethan the other opioids. In fact, multiple randomized controlled trials have found no major differences between morphine and other opioids in regard to analgesia and adverse effect profiles 1. The use and titration of methadone are complex and should preferably be reserved for professionals with a high level of expertise, such as supportive or palliative care specialists and pain medicine specialists 1. Concerns have been raised about the efficacy of buprenorphine, owing to its partial agonist activity, which might result in limited additional analgesic benefit but increased likelihood of adverse reactions
Pain Management in Patients with Cancer: Focus on Opioid Analgesics
Current Pain and Headache Reports, 2011
Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant analgesics. Weak opioids are used for mild-to-moderate pain as monotherapy or in a combination with nonopioids. For patients with moderateto-severe pain, strong opioids are recommended as initial therapy rather than beginning treatment with weak opioids. Adjunctive therapy plays an important role in the treatment of cancer pain not fully responsive to opioids administered alone (ie, neuropathic, bone, and visceral colicky pain). Supportive drugs should be used wisely to prevent and treat opioids' adverse effects. Understanding the pharmacokinetics, pharmacodynamics, interactions, and cautions with commonly used opioids can help determine appropriate opioid selection for individual cancer patients.
The efficacy of opioids in cancer pain syndromes
Pain, 1994
The treatment of pain in the patient with cancer necessitates careful assessment and definition of factors contributing to the pain complaint. We describe 3 cases of patients who had cancer, complained of pain, and were inappropriately treated with escalating doses of opioids. Opioid analgesic medications are commonly used in the management of pain in patients with cancer. Failure to respond to this treatment, the development of increasing pain, and the report of new side effects should prompt reassessment of opioid use.
Pharmacotherapy of cancer pain with opioid analgesics
Hospital Pharmacology - International Multidisciplinary Journal
Introduction: Selection of analgesics should be based on the World Health Organization (WHO) analgesic ladder, beginning with non-opioid analgesics in combination with adjuvants for mild pain, weak opioids with adjuvants are indicated for moderate pain, while potent opioids, non-opioids and adjuvants are recommended for severe pain. Methods: The facts presented in this paper are expanded by searching for recent literature data in the following index-data-bases: SCI index, PubMed, Google Scholar, Scopus, and by using adequate key words. The idea supporting this paper was to make practice easier for clinicians who are engaged in supportive oncology and to help in adequate and up-to-date malignant pain management in oncology patients in everyday practice. Topic: Initial opioid dose should be low, and long-acting opioid dose should be gradually increased and titrated considering daily requirements of short-acting opioid formulation due to pain breakthrough. It is mandatory for patients ...
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 2016
Guidelines tend to consider morphine and morphine-like opioids comparable and interchangeable in the treatment of chronic cancer pain, but individual responses can vary. This study compared the analgesic efficacy, changes of therapy and safety profile over time of four strong opioids given for cancer pain. In this four-arm multicenter, randomized, comparative, of superiority, phase IV trial, oncological patients with moderate to severe pain requiring WHO step III opioids were randomly assigned to receive oral morphine or oxycodone or transdermal fentanyl or buprenorphine for 28 days. At each visit, pain intensity, modifications of therapy and adverse drug reactions (ADRs) were recorded. The primary efficacy end point was the proportion of nonresponders, meaning patients with worse or unchanged average pain intensity (API) between the first and last visit, measured on a 0-10 numerical rating scale. (NCT01809106). Forty-four centers participated in the trial and recruited 520 patients...