Morphine as first medication for treatment of cancer pain

Nunes, Beatriz Coronato; Garcia, João Batista dos Santos; Sakata, Rioko Kimiko

doi:10.1016/j.bjane.2013.06.016

Cited by 5 publications

(9 citation statements)

References 20 publications

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“…In reviewing the 25 included studies, all of the studies used convenience samples, while only four of the convenience samples were randomized. The four studies that used randomized samples were for the purposes of evaluating the necessity of Step 2 of the WHO analgesic ladder 30 – 32 ( Figure 1 ) or the use of mild opiates. 33 Nineteen of the studies were prospective studies, including six quasiexperimental studies in which four used comparison groups.…”

Section: Resultsmentioning

confidence: 99%

“… 33 Nineteen of the studies were prospective studies, including six quasiexperimental studies in which four used comparison groups. Only two studies had a control group 32 , 34 and one study was double-blind. 35 Because of the lack of control groups throughout all but two of the 25 studies, meta-analysis was not performed.…”

Section: Resultsmentioning

confidence: 99%

“…Several of the studies reviewed used patient responses on either a VAS or NRS where the percentage of the pain reduction in the scores after initiation of treatment was stated or could be calculated. 28 , 32 , 33 , 38 – 45 An analysis of the study results at one interval of measurement (∼3–7 days after treatment was initiated) demonstrated a 20%–71% reduction in the VAS or NRS from the baseline pain assessment. Upon the final interval of measurement, there was a 43%–81% reduction in the VAS or NRS from the baseline pain assessment.…”

Section: Resultsmentioning

confidence: 99%

“…12 , 50 , 51 Because only one study met inclusion criteria after 2008, it is questioned whether this finding indicates recognition of the WHO guidelines, and hence a decreased need for publications of their effectiveness or the acceptance of the treatment of cancer pain with opioids. 32 The timeframe correlates with the publication of the European Association for Palliative Care guidelines 52 , 53 and the American Pain Society guidelines for cancer pain treatment. 54 , 55 These agency guidelines have recognized the worldwide problem of cancer pain, combined with the increasing availability of different opioids, opioid preparations, and interventional procedures during the last 20 years.…”

Section: Discussionmentioning

confidence: 99%

“… 11 A ceiling effect occurs when an increase in dose does not produce a decrease in pain. In an attempt to avoid using weak opioids, Nunes et al 32 found that a higher incidence of adverse effects occurred when the second step of the ladder was omitted and patients were administered morphine initially. Thus, Step 2 may still be warranted, and future research is needed to explore its value.…”

Section: Limitationsmentioning

confidence: 99%

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Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Carlson

2016

JPR

122

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Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Carlson

2016

JPR

122

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Effects of Good Pain Management (GPM) ward program on patterns of care and pain control in patients with cancer pain in Taiwan

Chuang

Chen

et al. 2020

Support Care Cancer

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Background The undertreatment of cancer pain is a global issue although many international guidelines and various studies bloom to explore the approaches in pain management. However, there is no standard care for cancer pain in routine practices. To set up a standardized procedure for improving cancer pain management in Taiwan, the Good Pain Management (GPM) program is explored to provide treatments following the US National Cancer Care Network (NCCN) Adult Cancer Pain Guideline. Method Patients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Pain control, adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses based on the pain medication category were also conducted. Result Fifty-one patients were enrolled, with 26 and 25 assigned to the GPM and control arms, respectively. Significant differences among the GPM and control arms were found including a greater decrease in the mean numerical rating scale (NRS) score in the GPM arm (− 4.6 vs. − 2.8), a lower proportion of moderate-to-severe pain in the GPM arm (23.2% vs. 39.8%), and a higher pain management index (PMI) score in the GPM arm (0.64 points vs. 0.33 points) (all p < 0.05). Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm. Conclusion In summary, our study demonstrated that the implementation of a standardized pain assessment and management approach (GPM ward program) showed significant improvements on pain relief, decreased the portion of moderate-to-severe cancer pain, and increased patient satisfaction in the 1st 48 h after admission. The implementation of the GPM approach in the cancer ward may provide sooner and better improvement of cancer pain management for patients who suffered moderate-tosevere cancer pain. Trial registration ClinicalTrials.gov (Identifier: NCT03155516) Keywords Good pain management. Pain control. Adequacy of pain treatment. Cancer pain Wei-Chih Su and Chieh-Han Chuang contributed equally to this work.

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Chronic and Refractory Pain: A Systematic Review of Pharmacologic Management in Oncology

Brant

Keller

McLeod

et al. 2017

CJON

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Morphine as first medication for treatment of cancer pain

Abstract: the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.

Cited by 5 publications

References 20 publications

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Effects of Good Pain Management (GPM) ward program on patterns of care and pain control in patients with cancer pain in Taiwan

Chronic and Refractory Pain: A Systematic Review of Pharmacologic Management in Oncology

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