Intravenous Patient-Controlled Analgesia Versus Oral Opioid to Maintain Analgesia for Severe Cancer Pain: A Randomized Phase II Trial

Abstract

Background: Optimal analgesic maintenance for severe cancer pain is unknown. This study evaluated the efficacy and safety of intravenous patient-controlled analgesia (IPCA) with continuous infusion plus rescue dose or bolus-only dose versus conventional oral extended-release morphine as a background dose with normal-release morphine as a rescue dose to maintain analgesia in patients with severe cancer pain after successful opioid titration. Methods: Patients with persistent severe cancer pain (≥7 at rest on the 11-point numeric rating scale [NRS]) were randomly assigned to 1 of 3 treatment arms: (A1) IPCA hydromorphone with bolus-only dose where dosage was 10% to 20% of the total equianalgesic over the previous 24 hours (TEOP24H) administered as needed, (A2) IPCA hydromorphone with continuous infusion where dose per hour was the TEOP24H divided by 24 and bolus dosage for breakthrough pain was 10% to 20% of the TEOP24H, and (B) oral extended-release morphine based on TEOP24H/2 × 75% (because of incomplete cross-tolerance) every 12 hours plus normal-release morphine based on TEOP24H × 10% to 20% for breakthrough pain. After randomization, patients underwent IPCA hydromorphone titration for 24 hours to achieve pain control before beginning their assigned treatment. The primary endpoint was NRS over days 1 to 3. Results: A total of 95 patients from 9 oncology study sites underwent randomization: 30 into arm A1, 32 into arm A2, and 33 into arm B. Arm B produced a significantly higher NRS over days 1 to 3 compared with arm A1 or A2 (P<.001). Daily NRS from day 1 to day 6 and patient satisfaction scores on day 3 and day 6 were worse in arm B. Median equivalent-morphine consumption increase was significantly lower in A1 (P=.024) among the 3 arms. No severe adverse event occurred in any arm. Conclusions: Compared with oral morphine maintenance, IPCA hydromorphone for analgesia maintenance improves control of severe cancer pain after successful titration. Furthermore, IPCA hydromorphone without continuous infusion may consume less opioid.

Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: a national survey

“…PCA offers a more efficient analgesic approach that improves pain relief and patient satisfaction ( 28 , 29 ). About 32.8% of participants viewed PCA as suitable for refractory cancer pain cases, primarily due to patients experiencing systemic high-dose opioid use or intolerable side effects.…”

Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial

“…1 Cancer-related pain is the most important factor affecting cancer patients' quality of life. 2 However, effective and fast-onset treatment for cancer pain is still lacking. [3][4][5] Determining the ideal therapeutic opioid dose is the key to successfully controlling cancer pain.…”

“…Patient-controlled analgesia (PCA) technology can be used to titrate hydromorphone. 2 Patient-controlled subcutaneous analgesia (PCSA) is used to administer drugs into subcutaneous tissues to achieve the same analgesic effects as intramuscular and intravenous administration. During PCSA, relatively simple monitoring, management, and nursing are needed, and it is associated with few complications, good patient compliance, high safety, and low medical costs.…”