Opioid combination for cancer pain

Mercadante, Sebastiano

doi:10.1038/sj.bjc.6601806

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…Currently there is a gulf between the basic scientific work which potentially supports a role for combination opioid therapy and clinical practice where combination therapy is used. The limited work in combination opioid therapy in cancer pain presented here 16,18 does not yet fully support this as evidence-based practice. Appropriately designed studies (appropriately powered; clear equianalgesic conversions; quantification of side effects) are needed to allow the role of combination opioid therapy to be assessed fully.…”

Section: Discussionmentioning

confidence: 73%

“…The equianalgesic conversion ratios were unclear, and the possibility of an inadequate washout period may have been present. 18 To provide good evidence, oxycodone and morphine should each have been titrated to analgesic effect in individual patients. Furthermore it would seem reasonable to conclude that patients who received less IR morphine would have fewer side effects.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of combination step III opioid therapy in cancer pain: An EPCRC opioid guideline project

Fallon

Laird

2011

Palliat Med

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Section: Discussionmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

A systematic review of combination step III opioid therapy in cancer pain: An EPCRC opioid guideline project

Fallon

Laird

2011

Palliat Med

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“…In patients with a poor analgesic response after opioid dose escalation, an addition of low doses of methadone to improve analgesia is reported effective. 22 Recent studies have reported that 50%-80% of patients with cancer-related pain have improved pain control after the addition of methadone, most likely benefitting from methadone's NMDA receptorinhibiting properties. 14,23,24 Indirectly, in most of our patients, this was supported by the observation that an increase of the primary strong opioid (with mu-receptor effect) did not improve pain control, whereas methadone did.…”

Section: Discussionmentioning

confidence: 99%

The Use of Low-Dose Methadone as Add-On to Regular Opioid Therapy in Cancer-Related Pain at End of Life: A National Swedish Survey in Specialized Palliative Care

Fürst

Lundström

Klepstad

et al. 2020

Journal of Palliative Medicine

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Background: Low-dose methadone in addition to another ongoing opioid therapy is a promising approach for managing complex cancer-related pain and is, despite limited evidence, used in clinical practice. Objective: To investigate the use of low-dose methadone in specialized palliative care in Sweden. Design: Specialized palliative care services in Sweden answered a survey regarding methadone use in individual patients over 12 months. Setting/Subjects: The survey was an add-on to the Swedish Register of Palliative Care's (SRPC) mandatory end-of-life questionnaire (ELQ). Results: Sixty of 133 invited units (45%) participated in the study. A total of 4780 ELQs were registered. Four hundred ten of these patients received methadone (9%). In 96% of these patients, methadone was prescribed as an add-on to ongoing opioid therapy, mostly because of poor pain control due to mixed nociceptive and neuropathic pain (70%). Methadone was used for a median of 21 days, in 86% of cases until death. Mean daily methadone doses increased from 7 mg at start to 21 mg (p < 0.005) during the last 24 hours. Corresponding morphine equivalent daily doses of other opioids were 184 and 199 mg (p < 0.05), respectively. A pain-relieving effect was reported in 94% of the patients. Adverse effects were seen in 20% of the patients; none of these was severe. Conclusion: The addition of low-dose methadone to an ongoing opioid therapy in patients with complex cancerrelated pain is well established in Swedish specialized palliative care. It appears to have good pain-relieving effects and to be safe.

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Opioids in pain management of blood-related malignancies

Niscola

Scaramucci²,

Romani³

et al. 2006

Ann Hematol

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Opioids are basic analgesics used in the treatment of moderate to severe pain in patients affected by blood-related malignancies. They should be sequentially administered according to the World Health Organisation scale for cancer pain. Initial treatment and titration with opioids should be based on immediate-release preparations, to be administered at appropriate intervals in order to relieve pain and to satisfy the individual opioid requirement. Once a relatively good pain control has been achieved, a slow release formulation at equivalent doses can be given. Most patients can be adequately managed using oral formulation opioids. However, a small group, such as those presenting severe mucositis or requiring a rapid pain relief, should be managed by intravenous continuous infusion and/or by a patient-controlled analgesia system; while for patients in the community, there are distinct advantages to using the subcutaneous route. Other available routes of administration for opioids, can be used in selected circumstances, including rectal, transdermal, epidural, intrathecal and intramuscular. The invasive neuraxial route has a very limited role in patients with haematological malignancies, given the high risk of infection and bleeding. Through a close observation and a careful management, opioid-related side effects can be effectively prevented and treated. This article reviews the principles of opioid therapy and how opioids can be adapted for patients with pain due to haematological malignancies.

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Opioid combination for cancer pain

Cited by 4 publications

References 3 publications

A systematic review of combination step III opioid therapy in cancer pain: An EPCRC opioid guideline project

A systematic review of combination step III opioid therapy in cancer pain: An EPCRC opioid guideline project

The Use of Low-Dose Methadone as Add-On to Regular Opioid Therapy in Cancer-Related Pain at End of Life: A National Swedish Survey in Specialized Palliative Care

Opioids in pain management of blood-related malignancies

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