Experience with oral morphine for cancer pain relief

Vijayaram, S.; Bhargava, K. P.; Ramamani,; Sudharshan,; Heranjal, Roshni; Lobo, Bridget

doi:10.1016/0885-3924(89)90006-7

Cited by 17 publications

(5 citation statements)

References 7 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%

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%

Opioid Therapy for Chronic Nonmalignant Pain

Portenoy

1995

Pain Research and Management

123

145

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“…My skeptical colleagues were upset, because they thought that the morphine might have led to the early demise of these patients. When the results of a study disproving this were published (17), those of us who had referred patients for cancer pain management based on the World Health Organization's pain relief ladder were tremendously relieved (6).…”

Section: Bkmmentioning

confidence: 99%

Learning Palliative Care in India: Two Personal Perspectives

Butola

Mohanti²

2013

J Palliat Care

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“…However, using current paintreatments cancer pain at all stages of the disease can almost always be treated and controlled effectively. Studies have shown that pain can be completely relieved in 80-90% of patients with cancer (3,5). It is therefore important that no patient should experience «unnecessary pain», e.g., a pain that is possible to treat but is not.…”

Section: Introductionmentioning

confidence: 99%