Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

Abstract

An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC + PRN opioid); to determine if there were differences in the severity of side effects among the four prescriptions groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of eleven side effects. Significant differences (P < 0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC + PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC + PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC + PRN prescription types and higher doses of opioid analgesics.

Opioid-induced constipation

“…These factors include, but are not limited to, advanced age, female gender, opioid strength/type, reduced mobility, dehydration, hypercalcemia, altered nutritional intake, anal fissures and mechanical obstruction of the bowel [15][16][17][18][19].…”

Pharmacological treatment of chronic pain – the need for CHANGE

“…It has been suggested that constipation is the most bothersome side effect, both in terms of its impact on daily life and the frequency of occurrence 54,55 , but nausea and vomiting have been described as highly distressing by patients, sufficient to make them reduce their opioid dose or stop taking it completely 56,57 . Sedation affects between 20% and 70% of patients receiving opioids 58 , but patients may also experience other CNS side effects including cognitive and psychomotor impairment, hallucinations, and toxic effects on neurons, such as hyperalgesia and analgesic tolerance 53 . Less frequently reported are pruritus, respiratory depression, immunological suppression and hormonal changes.…”

Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options

“…The major reasons for discontinuation of opioid analgesic treatment are gastrointestinal (GI) side effects (i.e., nausea, vomiting, and constipation) along with central nervous system side effects [12]. The incidence of nausea and vomiting reported in patients treated with opioids for chronic pain in a clinical trial setting ranges from 10% to 50% [13–16]. While other GI side effects of opioids such as constipation can be prevented and controlled to some degree by various measures such as laxatives, increased fiber consumption and stool softeners [11], nausea and vomiting effects are more difficult to control fully in the majority of patients [17].…”