Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review

McNicol, Ewan D; Horowicz-Mehler, N.; Fisk, Ruth A; Bennett, K C L B; Gialeli-Goudas, Maria; Chew, Priscilla; Lau, Joseph; Carr, Daniel B.

doi:10.1016/s1526-5900(03)00556-x

Cited by 397 publications

(295 citation statements)

References 77 publications

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“…Constipation is the most common adverse event associated with opioid use and occurs in 25%-50% of cancer patients. NCCN guidelines recommend instituting a bowel regimen to all patients on chronic opioids unless otherwise contraindicated [22,28] ( Table 6). …”

Section: Painmentioning

confidence: 99%

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Symptom Management in Metastatic Breast Cancer

2011

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Approximately 40,000 women die as a result of breast cancer each year and many more live with advanced disease. When breast cancer recurs, the goals of treatment often shift from one of cure to controlling the disease for as long as possible while palliating symptoms interfering with the patient's functional status and quality of life. This requires ongoing discussions with the patient and family about the goals of care. Many symptoms depend on the site of metastasis, with bone being the most frequent, and commonly occur with fatigue, depression, insomnia, and pain. The purpose of this paper is to identify and provide an overview of the management of the most common symptoms in patients with breast cancer metastases.

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Section: Painmentioning

confidence: 99%

“…Along with nausea and vomiting, patients with advanced cancer frequently report constipation (at least 50%), especially if they are being treated with opioids [28,62,85]. Prophylaxis and prevention of constipation with the goal of a soft bowel movement every 1-2 days should be initiated with the start of opioids.…”

Section: Gastrointestinal Symptomsmentioning

confidence: 99%

Symptom Management in Metastatic Breast Cancer

2011

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“…A number of systematic reviews have evaluated the prevalence of analgesic side effects associated with the treatment of cancer (1,4) and chronic noncancer (5)(6)(7)(8)(9) pain. Most prevalence rates were derived from adverse event data reported as a part of studies of new analgesics.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Cherny et al (1) identified six side effects that adversely impact oncology patients use of opioid medications, namely: nausea/vomiting, constipation, sedation, cognitive failure, myoclonus, and pruritis. McNicol et al (4) conducted a systematic review of 67 studies on the management of side effects associated with opioids. The side effects evaluated in this review were sedation, nausea/ vomiting, delirium, myoclonus, pruritis, respiratory depression, and constipation.…”

Section: Literature Reviewmentioning

confidence: 99%

Differences in the Prevalence and Severity of Side Effects Based on Type of Analgesic Prescription in Patients with Chronic Cancer Pain

Villars

Dodd

West

et al. 2007

Journal of Pain and Symptom Management

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An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC + PRN opioid); to determine if there were differences in the severity of side effects among the four prescriptions groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of eleven side effects. Significant differences (P < 0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC + PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC + PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC + PRN prescription types and higher doses of opioid analgesics.

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“…However, after studying adverse morphine effects in 122 Brazilian cancer children 7 , authors have observed that 72.9% of cases had constipation. Although being a relatively common manifestation in patients under opioids, it is worsened by several other factors such as malnutrition, dehydration and simultaneous use of other drugs, which are especially present in metastatic oncologic patients under palliative care 8 . Constipation is a challenge for the oncologic practice because it is often neglected by health professionals and caregivers, although being associated to several other symptoms, such as discomfort, abdominal pain, nausea, vomiting, fecal impaction with or without anal injury 4,5 , which invariably impact global health and quality of life of cancer patients, in addition to increasing the use of other drugs for relief or symptomatic treatment of symptoms and the rate of complications and costs related to such interventions.…”

Section: Introductionmentioning

confidence: 99%