The research on long-term clinical effects and patients’ satisfaction of gabapentin combined with oxycontin in treatment of severe cancer pain

Abstract

Gabapentin has been used as an adjuvant for treatment of cancer pain. Previous studies showed that opioids combined with gabapentin for management of cancer pain reduced the dosage of opioids.The objective of this study was to explore the clinical effect and patients’ satisfaction of oxycontin combined with gabapentin in treatment of severe cancer pain. After titration of morphine, 60 severe cancer patients with visual analog score (VAS) more than 7 were randomly divided into trial group (n = 30) and control group (n = 30). The control group was administered oxycontin and placebo, and the trial group was given oxycontin and gabapentin. VAS score was recorded pre- and post-treatment; while daily dose of oxycontin, daily cost of pain relief and life quality score were observed 1 week, 1 month, 2 months, 3 months, and 6 months post-treatment. We found that daily dose of oxycontin 1 month post was comparable between the 2 groups (P > 0.05). Three months post, compared with control group (58.0 ± 15.2 mg), average daily dose of oxycontin was significant lower in trial group (33.4 ± 11 mg) (P < 0.001). Average daily cost of pain relief in trail group (34.5 ± 10.2 RMB) was less than the control group (52.4 ± 13.7 RMB) (P < 0.001). Life quality score increased in all of the patients in both group post-treatment (P < 0.05); while life quality score in trail group was greater than in control group 3 months (46.8 ± 4.5 vs 43.5 ± 4.6, P = 0.007) and 6 months (46.5 ± 4.8 vs 41.4 ± 4.3, P < 0.001) post-treatment. The incidence of drowsiness and dizziness was comparable between the 2 groups (P > 0.05), while the incidence of nausea and vomiting (P = 0.038), and constipation (P < 0.001) was higher in the control group.We concluded that oxycontin combined with gabapentin used in severe cancer pain management can control pain effectively, decreased the dose of oxycontin and the cost of cancer pain relief, and reduced the incidence of nausea and vomiting, and constipation, increased the life quality.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…39 They have been studied primarily in noncancer neuropathy syndromes, 40 although data exist supporting their use for treatment of cancer pain in conjunction with opioids. 41,42 Gabapentin has been reported to reduce mucositis pain in patients receiving concomitant radiotherapy and chemotherapy. 43 When compared in a prospective, randomized, open-label trial, pregabalin relieved neuropathic cancer-related pain more effectively than transdermal fentanyl.…”

Risk of major adverse events associated with gabapentinoid and opioid combination therapy: A systematic review and meta-analysis

“…After 179 relevant articles were assessed for eligibility through a full-text evaluation, 43 studies with 6,537,444 patients were selected. TRAEs were reported in 26 RCTs ( Caraceni et al, 2004 ; Gilron et al, 2005 ; Fassoulaki et al, 2006 ; Turan et al, 2006 ; Keskinbora et al, 2007 ; Clarke et al, 2009 ; Gatti et al, 2009 ; Clendenen et al, 2010 ; Rapchuk et al, 2010 ; Pesonen et al, 2011 ; Yucel et al, 2011 ; Chaparro et al, 2012 ; Jain et al, 2012 ; Pota et al, 2012 ; Yadeau et al, 2012 ; Mercadante et al, 2013 ; Paul et al, 2013 ; Clarke et al, 2015 ; Chen et al, 2016 ; Dou et al, 2017 ; Wang et al, 2017 ; Hah et al, 2018 ; Jones et al, 2019 ; Hermann et al, 2020 ; Jung et al, 2020 ; Teng et al, 2021 ) and 7 non-RCTs ( Caraceni et al, 1999 ; Li et al, 2010 ; Savelloni et al, 2017 ; Peckham et al, 2018 ; Bykov et al, 2020 ; Chae et al, 2021 ; Dai et al, 2021 ); mortality was reported in 10 non-RCTs. ( Abrahamsson et al, 2017 ; Gomes et al, 2017 ; Gomes et al, 2018 ; Slavova et al, 2018 ; Macleod et al, 2019 ; Lynn et al, 2020 ; Waddy et al, 2020 ; Bishop-Freeman et al, 2021 ; Mariottini et al, 2021 ; Chen et al, 2022 ).…”

“…This meta-analysis included only randomized controlled trial (RCT) studies that mostly focused on the short-term use of perioperative analgesics. However, gabapentinoids are prescribed for long-term use for cancer-associated or non-cancer chronic pain, and their medication use could be different from RCT studies in actual clinical settings ( Chen et al, 2016 ; Yu et al, 2021 ).…”

“…RCTs(Caraceni et al, 2004;Gilron et al, 2005;Fassoulaki et al, 2006;Turan et al, 2006;Keskinbora et al, 2007;Clarke et al, 2009;Gatti et al, 2009;Clendenen et al, 2010;Rapchuk et al, 2010;Pesonen et al, 2011;Yucel et al, 2011;Chaparro et al, 2012;Jain et al, 2012;Pota et al, 2012;Yadeau et al, 2012;Mercadante et al, 2013;Paul et al, 2013;Clarke et al, 2015;Chen et al, 2016;Dou et al, 2017;Wang et al, 2017;Hah et al, 2018; Jones et al, 2019;Hermann et al, 2020;Jung et al, 2020;Teng et al, 2021) and 7 non-RCTs(Caraceni et al, 1999;Li et al, 2010;Savelloni et al, 2017;Peckham et al, 2018;Bykov et al, 2020;Chae et al, 2021;Dai et al, 2021); mortality was reported in 10 non-RCTs (Abrahamsson et al, 2017;Gomes et al, 2017; . Frontiers in Pharmacology frontiersin.org…”

High dose gabapentin does not alter tumor growth in mice but reduces arginase activity and increases superoxide dismutase, IL-6 and MCP-1 levels in Ehrlich ascites

“…No previous studies had demonstrated any findings that gabapentin might play a role in inflammation and in immunomodulation in an in vivo tumor model. These findings are relevant because gabapentin is frequently used in the management of severe pain, especially in cancer patients [16, 17].…”