A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

Abstract

BackgroundInter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients.MethodsWe conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsYoung age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol).ConclusionsFuture studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory.Trial registrationCRD42017057740.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4478-3) contains supplementary material, which is available to authorized users.

<p>Relationship Between Adherence to Opioid Analgesics and Pain Beliefs Among Patients with Cancer Pain at Tertiary Care Hospitals in Malaysia</p>

“…In this study, negative effect beliefs were moderately, negatively correlated with adherence, and similarly for pain endurance beliefs. These findings corresponded with results from other studies, which also found that the more negative beliefs the patient had regarding opioids 30 and cancer pain, 17 the poorer their adherence to ATC analgesics. This is likely because patients who have more concerns regarding cancer pain and analgesic use would more likely to be hesitant to use analgesics, thereby resulting in lower adherence levels.…”

“… 16 There are several published studies which have investigated the association between sociodemographic factors and cancer pain characteristics with analgesic adherence in cancer patients. 17 , 18 Factors that were linked with analgesic adherence include age, type of cancer, type of pain and other symptoms such as anxiety or sleep disturbance. 17 …”

“… 17 , 18 Factors that were linked with analgesic adherence include age, type of cancer, type of pain and other symptoms such as anxiety or sleep disturbance. 17 …”

Opioid response in paediatric cancer patients and the Val158Met polymorphism of the human catechol-O-methyltransferase (COMT) gene: an Italian study on 87 cancer children and a systematic review

“…Materials and methods of the present study have been already published in part by Lucenteforte et al 2018 [13]. Briefly, STOP Pain is a prospective observational cohort pilot study enrolling hospitalized patients (0–17 years) between June 2011 and December 2014.…”

The Complex Balance between Analgesic Efficacy, Change of Dose and Safety Profile Over Time, in Cancer Patients Treated with Opioids: Providing the Clinicians with an Evaluation Tool

“…Previous studies that evaluated opioid treatment outcomes showed only a measure of positive responses, based on pain reduction by ≥30% [7]. Also, in a recent meta-analysis examining the risk factors for clinical response to opioids, the analgesic effect was the only parameter evaluated [30]. The second strength of this study is the large sample of patients with a homogeneous stage of disease.…”