IntroductionOpioid analgesics are essential for treating cancer pain. However, patients are sometimes reluctant to use them because of concerns about addiction and dependence. Rapid pain relief following opioid administration may help overcome the psychological barriers to opioid analgesic use. This study aims to determine the relationship between psychological resistance to strong opioid analgesic use and pain amelioration speed in patients with advanced recurrent cancer.Methods and analysisThis ongoing, multicentre, observational study enrols patients aged 20 years or older with distant metastasis or advanced recurrent cancer receiving strong opioid analgesics for cancer pain for the first time. All participants, both inpatient and outpatient, were recruited from five Japanese hospitals. We are investigating the relationship between psychological barriers at the start of treatment and pain relief during the first week of treatment in these patients. The primary outcome is the Japanese version of the Barriers Questionnaire-II score at baseline. The secondary outcomes are the relationships between psychological barriers to strong opioid analgesic use and changes in pain over time. The participants are asked to fill out an electronic patient-reported outcome daily during the first week of treatment. The sample size was determined based on the number of patients in the year prior to study commencement who used strong opioid analgesics, met the eligibility criteria and could be expected to consent to participate in the study.Ethics and disseminationThe study protocol was approved by the ethics committee (approval ID B200600091) of Yokohama City University on 24 August 2020. The protocol has been reviewed by the institutional review boards at the four participating study sites. The results will be published in a peer-reviewed journal and will be presented at a relevant meeting.Trial registration numberUMIN000042443.

Purpose We aimed to gain insight into psychological barriers towards initiation of strong opioid analgesic use in patients with advanced, recurrent cancer. Methods This study included 46 patients who were prescribed with opioid analgesics for advanced, recurrent cancer. The primary outcome was psychological barriers assessed using the Japanese version of the Barriers Questionnaire-II (JBQ-II). The secondary outcomes were psychological changes and pain relief 1 week after the induction of strong opioid analgesics. Results The mean (S.D.) age of participants was 63.6 (11.1) years. Further, 26.1% had an Eastern Cooperative Oncology Group (ECOG) performance status of ≥ 3. The mean JBQ-Ⅱ total score was 1.97 (95% confidence interval: 1.75, 2.19). At the initiation of opioid therapy, there was no difference in the total scores between the baseline and 1 week later. Nevertheless, there was a significant difference in the subscale “disease progression” score (mean 2.97 vs 2.59, difference in means 0.38, standard error 0.16, p = 0.026). Personalized Pain Goal (PPG) was achieved in about half of the participants, and a trend toward a higher score in the subscale “harmful effects” (concern about adverse events) was observed in those who did not achieve PPG. Conclusion This study showed that patients with advanced, recurrent cancer have psychological barriers to opioid induction. The relationship between the presence of psychological barriers before and after induction of opioid analgesics and the speed of pain improvement was determined. The results may provide fundamental information for prospective intervention studies to develop individualized education programs for patients with psychological barriers to opioids.

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