Prolonged-release oxycodone–naloxone for treatment of severe pain in patients with Parkinson's disease (PANDA): a double-blind, randomised, placebo-controlled trial

Abstract

Mundipharma Research.

Comprehensive Examination of Therapies for Pain in Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…The number of trials for each identifiable therapeutic intervention category was 3 for dopaminergic agonists [17][18][19], 2 for cannabinoids and opioids [20,21], 3 for surgical methods [22][23][24], 4 for electrical or Chinese therapies [25][26][27][28], 2 for pardoprunox [29,30], 2 for safinamide [16], 1 for catechol-O-methyltransferase (COMT) inhibitors [31], 1 for multidisciplinary team care [32], and 7 for miscellaneous therapies. Miscellaneous therapies included hydrotherapy [33,34], massage therapy [35], gym training [36], mindfulness therapy [37], vibration therapy [38], and power yoga [39] (Table 1, with further intervention details in Appendix 4).…”

“…Pain severity was reported in 8 trials using the pain subscale of the Visual Analogue Scale (VAS-P) [17,24,26,27,29,30,33,35], in 8 using section 39 of the Parkinson's Disease Questionnaire-39 [16,22,23,31,32,36,37,39], in 4 using the Likert pain scale [18,19,34,38], in 1 using the King Parkinson's Disease Pain Scale [21], in 1 using question 1.9 of the Movement Disorders Society -Unified Parkinson's Disease Rating Scale (MDS-UPDRS Q1.9) [25], in 1 using the McGill Pain Scale [20], and in 1 trial using the Daily Pain Rating Sheet [28] (Table 1).…”

“…Ten studies qualified for the secondary sensitivity analysis, of which 2 were dopaminergic agonists [17,19], 1 was part of the cannabinoids and opioids class [21], 3 among the electrical and Chinese therapies [25,27,38], and 1 each for miscellaneous therapies [37], pardoprunox [30], safinamide [16], and COMT inhibitors [31]. Cannabinoids and opioids experienced a -0.02-unit reduction in pain severity (SMD = -2.26 vs. SMD = -2.24), electrical and Chinese therapies displayed a -0.13-unit reduction in pain severity (SMD = -1.11 vs. SMD = -0.98), and a -0.12-unit reduction in pain severity was seen for pardoprunox (SMD = -0.62 vs. SMD = -0.50).…”

Therapies for Pain in Parkinson Disease: Concerns Related to a Meta-Analysis on Treating Different Types of Pain as if They Were the Same

“…This is not the first time that clinical trials on pain in PD have been critiqued for failing to separate subtypes of pain. In Lancet Neurology [15], a 2015 commentary noted that a just-published 16-week randomized controlled clinical trial of oral prolonged-release oxycodone-naloxone [16] did not find that this powerful drug differed from placebo on its primary endpoint of average 24-h pain score, but post hoc analysis did reveal improved pain severity for certain subgroups. The commentary authors note the importance of proper, standardized and well-characterized subgroups of pain in patients with PD, when conducting or summarizing randomized controlled clinical trials on this topic.…”

Unmet needs in Parkinson's disease: New horizons in a changing landscape

“…Although some evidence supports the efficacy of certain treatments for depression, dementia, psychosis, constipation, orthostatic hypotension and sialorrhea, there is insufficient evidence for efficacious treatments for other important non-motor symptoms that certainly contribute to poor quality of life, such as neurogenic bladder disturbance, erectile dysfunction, fatigue, insomnia, apathy, anxiety and excessive daytime sleepiness [60,63]. The emergence of recent controlled trials concentrated on key non-motor issues such as Parkinson associated pain [64] or sleep [65] is highly encouraging. Nevertheless, the broad spectrum of NMS in PD clearly highlight the need for developing non-dopaminergic therapies that target the nondopaminergic degeneration in PD.…”