A long-term survey of morphine in cancer pain patients

Schug, Stephan A.; Zech, D.; Grond, Stefan; Jung, Helena; Meuser, Thomas; Stobbe, B.

doi:10.1016/0885-3924(92)90059-q

Cited by 139 publications

(94 citation statements)

References 28 publications

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“…Numerous studies have confirmed that opioid treatment provides adequate relief to 70 to 90% of patients with cancer pain (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Rather than augmenting patient distress, opioid therapy is widely perceived to be an effective means to temper it and offers the opportunity for better function and quality of life (33,34).…”

Section: Implications Of Clinical Experience In the Cancer Populationmentioning

confidence: 99%

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Opioid Therapy for Chronic Nonmalignant Pain

Portenoy

1995

Pain Research and Management

123

145

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RK Portenoy.Opioid therapy for chronic nonmalignant pain. Pain Res Manage 1996;1(1):17-28. Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours. Key Words: Addiction, Drug dependence, Nonmaligant pain, Opioids, Pain therapyThérapie opioïde pour la douleur chronique non cancéreuse RÉSUMÉ : L'administration à long terme d'un médicament opioïde pour traiter la douleur chronique non cancéreuse reste sujet à controverse mais n'est plus rejetée de façon uniforme par les spécialistes de la douleur. Ceci est vrai même si l'on s'inquiète de ce que les organismes régulateurs qui supervisent la prescription médicale d'agents opioïdes persistent à stigmatiser cette pratique. Le changement de perspective clinique a été motivé en partie par une reconnaissance généralisée des résultats remarquablement favorables obtenus lors du traitement opioïde de la douleur cancéreuse. Ces résultats contrastent carrément avec ce qui est généralement enseigné sur l'administration à long terme d'un médicament opioïde et, confirment un potentiel d'efficacité durable, des effets secondaires supportables, une augmentation de la capacité fonctionnelle associée à une amélioration du bienêtre et, un risque minimal de comportements aberrants liés au médicament compatibles avec une toxicomanie. Une vaste expérience anecdotique chez des populations souffrant d'une douleur non cancéreus...

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Section: Implications Of Clinical Experience In the Cancer Populationmentioning

confidence: 99%

“…Specifically, many surveys have demonstrated that opioid doses typically stabilize during long term administration (17,24,62,(64)(65)(66)69,99,(109)(110)(111)(112)(113). When the need for dose escalation occurs, it is usually readily explained by a worsening physical lesion (24,114) or a changing psychological state (115).…”

Section: Therapeutic Efficacymentioning

confidence: 99%

Opioid Therapy for Chronic Nonmalignant Pain

Portenoy

1995

Pain Research and Management

123

145

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“…This question cannot be answered easily, because it depends mostly on the clinical situation [13,16]. Important features to consider are I Potency and maximum efficacy I Speed of onset and duration of effect I Possible modes of administration I Tolerability and spectrum of side-effects For most cancer pain patients, pain intensity can be so severe that agonist-antagonist drugs are not effective enough for longer treatment periods.…”

Section: Which Drug?mentioning

confidence: 99%

Opioids: overview on action, interaction and toxicity

Lehmann

1997

Support Care Cancer

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“…Although there have been a number of papers examining the effects of morphine in cancer patients in terms of analgesia and side effects [20,32], there have been few studies specifically focusing on the constipating effects of opioids in cancer patients. The numbers of patients included in these studies have tended to be small [1,5,25].…”

Section: Introductionmentioning

confidence: 99%