Hydromorphone for cancer pain

Abstract

This review indicated little difference between hydromorphone and other opioids in terms of analgesic efficacy. Data gathered in this review showed that hydromorphone had a similar effect on participant-reported pain intensity as reported for oxycodone and morphine. Participants generally achieved no worse than mild pain after taking hydromorphone, which is comparable with the other drugs. It produced a consistent analgesic effect through the night and could be considered for use in people with cancer pain experiencing sleep disturbance. However, the overall quality of evidence was very low mainly due to risk of bias, imprecision of effect estimates and publication bias. This review only included four studies with limited sample size and a range of study designs. Data for some important outcomes, such as impact of the treatment on consciousness, appetite or thirst, were not available. Therefore, we were unable to demonstrate superiority or inferiority of hydromorphone in comparison with other analgesics for these outcomes. We recommend that further research with larger sample sizes and more comprehensive outcome data collection is required.

The Conversion Ratio From Intravenous Hydromorphone to Oral Opioids in Cancer Patients

“…16 A Cochrane review concluded that hydromorphone has an analgesic efficacy that is similar to morphine and oxycodone in cancer patients. 14 There are limited studies regarding opioid conversions and rotations involving IV hydromorphone. Although the conversion ratio (CR) of IV morphine to oral morphine is well established, 6,17 the same is not true for hydromorphone.…”

Engagement of signaling pathways of protease-activated receptor 2 and μ-opioid receptor in bone cancer pain and morphine tolerance

“…Although opioids such as morphine are used for the treatment of advanced bone cancer pain, an increasing dose of morphine is required . Given that the side effects caused by a higher dose of morphine, the development of a novel strategy to enhance the analgesic effects of morphine to control bone cancer pain and further to reduce its side effects also becomes an important issue for treatment and management of patients with advanced bone cancer …”

“…5 Given that the side effects caused by a higher dose of morphine, the development of a novel strategy to enhance the analgesic effects of morphine to control bone cancer pain and further to reduce its side effects also becomes an important issue for treatment and management of patients with advanced bone cancer. [6][7][8] To study bone cancer-induced pain, a rat model has been commonly used. 9,10 Rat mammary gland carcinoma cells (i.e., breast sarcocarcinoma Walker 256 cells) are implanted into the tibia bone cavity and this can develop significant mechanical and thermal hyperalgesia.…”

SEOM clinical guideline for treatment of cancer pain (2017)

“…The latest review involved 604 patients from four trials that compared hydromorphone to oxycodone or morphine. Similar analgesic efficacy was demonstrated between groups with both comparisons ( level of evidence II, degree of recommendation A ) [ 27 ].…”