Opioids for cancer pain - an overview of Cochrane reviews

Abstract

The amount and quality of evidence around the use of opioids for treating cancer pain is disappointingly low, although the evidence we have indicates that around 19 out of 20 people with moderate or severe pain who are given opioids and can tolerate them should have that pain reduced to mild or no pain within 14 days. This accords with the clinical experience in treating many people with cancer pain, but overstates to some extent the effectiveness found for the WHO pain ladder. Most people will experience adverse events, and help may be needed to manage the more common undesirable adverse effects such as constipation and nausea. Perhaps between 1 in 10 and 2 in 10 people treated with opioids will find these adverse events intolerable, leading to a change in treatment.

Patients' Self-Assessment of the Symptoms and Impact of Opioid-Induced Constipation: Results From a Prospective Observational Cohort Study of Japanese Patients With Cancer

“…2 For these patients, health care providers (HCPs) prescribe oxycodone, morphine, fentanyl, and other opioid analgesics, which are highly effective for alleviating cancer-related pain. 3,4 However, gastrointestinal (GI) side effects are common with these drugs because they stimulate peripheral m-opioid receptors in the GI tract, resulting in delayed gastric emptying, oral-cecal transit, and colonic transit. 5 Opioidinduced constipation (OIC) is the most common GI side effect of opioid therapy, resulting in the discontinuation of opioid treatment or reduction in opioid dose, compromising effective pain relief.…”

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

“…Nevertheless, opioids are considered the mainstay of pain management. While opioids are frequently prescribed for the treatment of acute pain and cancer‐related pain , there is less consistent evidence for their use in the treatment of chronic non‐cancer pain . As many individuals who develop opioid use disorders may do so in the context of prescription opioid use for chronic non‐cancer pain , prescribing patterns may play a significant role in the development of opioid‐related problems in this population.…”

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

“…The Centers for Disease Control and Prevention (CDC) released guidelines for opioid prescribing for chronic pain in 2016 that specifically did not include cancer patients due to concerns regarding the complexity of cancer‐related pain as well as beliefs that opioid misuse was not an issue in patients with cancer . Moreover, the World Health Organization and other national guidelines have supported the use of opioids in the cancer population . The support for opioid use in cancer patients is likely the result of both a perception of the lack of abuse concern and clinical need for opioid use in the treatment of cancer‐related pain.…”

“…24 Moreover, the World Health Organization and other national guidelines have supported the use of opioids in the cancer population. 34,35 The support for opioid use in cancer patients is likely the result of both a perception of the lack of abuse concern and clinical need for opioid use in the treatment of cancer-related pain. Opioids are often considered to be first-line analgesics in the oncology setting due to concerns that the use of over-the-counter pain medications, including acetaminophen and nonsteroidal anti-inflammatory medications (NSAIDS), may mask important clinical symptoms such as fever, which can indicate a medical emergency.…”