Double-blind, placebo-controlled study of salmon calcitonin's potentiation of Morphine's analgesic effect against cancer pain

Rossano, C; Firetto, V.; Longoni, A.; Bottani, M.S.; Bartucci, F.

doi:10.1016/s0011-393x(05)80694-0

Cited by 2 publications

(16 citation statements)

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“…The collected study characteristics included author, published year, number of participants, type of cancer, intervention, level of epidural injection, method of drug delivery, duration of treatment, and results. Among the nine RCTs, two compared epidural to systemic opioids, 21,26 while the other seven investigated adjuvants, injection level, or type of administration for epidural analgesia in patients with intractable cancer pain 22–25,27–29 . Overall, 15 observational studies used opioids as epidural analgesic.…”

Section: Resultsmentioning

confidence: 99%

“…Five of the nine RCTs delivered epidural medications via an implanted pump or port, 21–23,25,26 three indwelled a catheter, 24,27,28 and one prescribed a single dose of drugs 29 . Of the 15 observational studies, implantable systems were inserted in seven, 33–35,39,40,42,43 and eight used short‐term catheters for epidural drug delivery 30‐32,36‐38,41,44 …”

Section: Resultsmentioning

confidence: 99%

“…Epidural analgesia had a superior effect when combined with calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone. Rossano et al 24 investigated 20 patients receiving epidural morphine alone or combined with synthetic salmon calcitonin (sCT) and concluded that sCT potentiated the analgesic effect of morphine and reduced the dose requirement. Eisenach et al 25 compared epidural morphine plus clonidine to epidural morphine alone, defining successful analgesia as a decrease in VAS or daily morphine use.…”

Section: Resultsmentioning

confidence: 99%

“…The combination of epidural opioids and local anesthetics can effectively relieve pain in the included studies. Of the epidural adjuvants, the analgesic effect of epidural opioids was superior when combined with calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone 24,25,27,29 . Single‐dose medication, short‐term catheters, subcutaneous tunneled catheters, or implantable systems, such as pumps or ports, could be used for epidural drug delivery.…”

Section: Discussionmentioning

confidence: 99%

“…The results and methods used for evaluating the quality of life were heterogenous among studies. Morphine consumption was decreased when combined with epidural calcitonin or ketamine compared to administration of epidural morphine alone 24,27 . Patients in the observational studies could have lower opioid consumption after epidural analgesia than their opioid requirement before treatment.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of epidural analgesia for intractable cancer pain: A systematic review

et al. 2023

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BackgroundEpidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk‐of‐bias tool or Newcastle‐Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta‐analysis reporting guideline.ResultsOur systematic review included nine randomized controlled trials (n = 340) and 15 observational studies (n = 926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug‐related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta‐analysis and evidence‐level determination.ConclusionCoadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high‐quality studies are required.

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Section: Resultsmentioning

confidence: 99%