The use of opioids for treatment of cancer pain

Mercadante, Sebastiano

doi:10.1517/14656566.2015.989213

Cited by 14 publications

(12 citation statements)

References 52 publications

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“…Strong and high-potency opioids, such as morphine, oxycodone, hydromorphone, methadone, fentanyl, and buprenorphine, are used as a last resort for severe pain of which adequate relief with weak opioids is not achieved. 13 However, physicians are often reluctant to use strong opioids for fear of their adverse effects, in particular, addiction. 14 When used appropriately, consumption of opioids in a country can be a good proxy for determining the quality of palliative cancer care.…”

Section: Introductionmentioning

confidence: 99%

Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

Wang

Huang

et al. 2017

JGO

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PurposeThe number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer.MethodsWe describe procedures for the selection, implementation, and assessment procedures for model cancer wards. We analyzed published results in areas of staff training and patient education, pain management in practice, analgesic drugs administration, and patient follow-up and satisfaction.ResultsPain management training enabled medical staff to accurately assess the level of pain and to provide effective pain relief through timely dispensation of medication. Patients with good knowledge of treatment of pain were able to overcome their aversion to opioid drugs and cooperate with nursing staff on pain assessment to achieve effective drug dose titration. Consumption of strong opioid drugs increased significantly; however, there was no change for weaker opioids. Higher pain remission rates were achieved for patients with moderate-to-severe pain levels. Proper patient follow-up after discharge enabled improved outcomes to be maintained.ConclusionThe GPM program has instituted a consistent and high standard of care for pain management at cancer wards and improved the quality of life for patients with cancer.

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Section: Introductionmentioning

confidence: 99%

Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

Wang

Huang

et al. 2017

JGO

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“…Adequate pain control is achieved in most patients with available analgesic therapies [2]. However, despite adequate pain control for most hours of the day, patients may develop transient flares of pain throughout the day.…”

Section: Introductionmentioning

confidence: 99%

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

et al. 2016

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IntroductionAn ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.MethodsThirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.ResultsBackground pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.ConclusionsThese preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.FundingMolteni Farmaceutici, Italy.

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“…As suggested in National Comprehensive Cancer Network (NCCN) guidelines, pain management contributes to broad quality-of-life improvement ( www.nccn.org ) [ 1 , 2 ]. As pain killer for moderate to severe pain, opioids, like morphine, oxycodone and fentanyl approved by FDA, are widely used for pain management of cancer patients, particularly those with advanced diseases [ 3 , 4 ]. Because of potential drug abuse, tolerance development, addiction and other side effects of opioids, opioid administration is under tight regulation to limit the usage and to avoid possible abuse.…”

Section: Introductionmentioning

confidence: 99%

Opioid doses required for pain management in lung cancer patients with different cholesterol levels: negative correlation between opioid doses and cholesterol levels

Huang

Liang

et al. 2016

Lipids Health Dis

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BackgroundPain management has been considered as significant contributor to broad quality-of-life improvement for cancer patients. Modulating serum cholesterol levels affects analgesia abilities of opioids, important pain killer for cancer patients, in mice system. Thus the correlation between opioids usages and cholesterol levels were investigated in human patients with lung cancer.MethodsMedical records of 282 patients were selected with following criteria, 1) signed inform consent, 2) full medical records on total serum cholesterol levels and opioid administration, 3) opioid-naïve, 4) not received/receiving cancer-related or cholesterol lowering treatment, 5) pain level at level 5–8. The patients were divided into different groups basing on their gender and cholesterol levels. Since different opioids, morphine, oxycodone, and fentanyl, were all administrated at fixed low dose initially and increased gradually only if pain was not controlled, the percentages of patients in each group who did not respond to the initial doses of opioids and required higher doses for pain management were determined and compared.ResultsPatients with relative low cholesterol levels have larger percentage (11 out of 28 in female and 31 out of 71 in male) to not respond to the initial dose of opioids than those with high cholesterol levels (0 out of 258 in female and 8 out of 74 in male). Similar differences were obtained when patients with different opioids were analyzed separately. After converting the doses of different opioids to equivalent doses of oxycodone, significant correlation between opioid usages and cholesterol levels was also observed.ConclusionsTherefore, more attention should be taken to those cancer patients with low cholesterol levels because they may require higher doses of opioids as pain killer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-016-0212-9) contains supplementary material, which is available to authorized users.

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The use of opioids for treatment of cancer pain

Cited by 14 publications

References 52 publications

Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Opioid doses required for pain management in lung cancer patients with different cholesterol levels: negative correlation between opioid doses and cholesterol levels

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