Management of cancer pain: 1. Wider implications of orthodox analgesics

Abstract

In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA “mimetics” (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients.

Effect of mu Agonists on Long-Term Survival and Recurrence in Nonsmall Cell Lung Cancer Patients

“…Postoperative mu agonists, playing the role as both “fertilizer” and “pesticide” for the “seed” CTCs, can protect and enhance the proliferation and function of CTCs during perioperative period. 8 Vitro studies indicated that mu agonists could increase the number of CTCs by accelerating cell cycle progression and cancer cell replication and by inhibiting apoptosis. 33 Moreover, mu agonists could promote CTCs on the function of invasiveness and metastasis.…”

“… 7 What is more, it has been reported that morphine may promote cell cycle progression, angiogenesis, and metastasis, and inhibit apoptosis through binding to mu-opioid receptor (MOR). 8 Otherwise, opioids also depress host immunity and alter neuroendocrine system function. 9 , 10 …”

Unveiling the Impact of Morphine on Tamoxifen Metabolism in Mice in vivo

“…Morphine and tamoxifen co-treatments are given after surgeries or in the case of severe cancer pain (27). Otherwise, codeine and/or paracetamol are widely prescribed (8). In human, these two compounds are metabolized by the same CYPs (6D6/3A4) and UGTs (1A10, 1A4, 1A8, 2B7, and 2B15) (28, 29) as tamoxifen and might have a more complex impact on tamoxifen metabolic pathways (30,31).…”

“…Cancer-associated pain resulting from metastases, anticancer treatment or surgery represents a major problem that is treated with analgesic drugs including morphine, codeine, and/or paracetamol (8). Morphine remains the gold standard for moderate and severe pain relief despite side effects that limit its chronic use (9).…”