No pain relief from morphine?

Riley, Julia; Ross, Joy; Rutter, D.V.; Wells, Athol U.; Goller, K; Bois, RM du; Welsh, Ken I.

doi:10.1007/s00520-005-0843-2

Cited by 112 publications

(26 citation statements)

References 19 publications

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“…It can be used safely in elderly patients and in mild/moderate renal impairment [42,43,44,45]. Patient preference for oxycodone compared to morphine has also been identified [46, 47]. …”

Section: Why Use Oxycodone?mentioning

confidence: 99%

Neuropathic Pain – The Case for Opioid Therapy

Allen

2008

Oncology

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For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or ‘normal’ pain. We also now recognise the great burden that NeP has on the lives of patients – it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient’s quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment. Greater understanding of the pathophysiology of NeP has led to more appropriate therapy and an increased use of multiple drug therapy – ‘rational polypharmacy’. Traditional opinions concerning the treatment of NeP have been challenged and it is because of this that the use of opioids in NeP has been re-evaluated. Opioids will never replace tricyclic antidepressants and anti-epileptic drugs as first-line therapy for NeP. However, they are now fully established as effective and useful second- or third-line drugs. Many patients in the past have been potentially undertreated as a result of our inertia to use opioids. The case for opioid therapy in NeP has been firmly established.

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“…It can be used safely in elderly patients and in mild/moderate renal impairment [42,43,44,45]. Patient preference for oxycodone compared to morphine has also been identified [46, 47]. …”

Section: Why Use Oxycodone?mentioning

confidence: 99%

Neuropathic Pain – The Case for Opioid Therapy

Allen

2008

Oncology

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“…Five open-label studies on oxycodone and cancer pain were also identified (table 2) [18,19,20,21,22]. The total number of patients followed by these studies was 608.…”

Section: Resultsmentioning

confidence: 99%

“…There was a sustained efficacy over long periods of time and most side effects were tolerable. One of the studies uses oxycodone as a first-line alternative opioid to morphine for opioid rotation or switching [22]. …”

Section: Resultsmentioning

confidence: 99%

Oxycodone and the Challenge of Neuropathic Cancer Pain: A Review

Olarte

2008

Oncology

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In order to evaluate the potential role of oxycodone in cancer pain management, neuropathic cancer pain was selected as a model for difficult pain syndromes. A nonsystematic, yet exhaustive, review of the literature provided the relevant evidence for the discussion. Ten randomized controlled trials (RCTs) and 5 open-label studies on oxycodone and cancer pain, 3 RCTs and 1 open-label study on oxycodone and neuropathic pain, and 2 RCTs on oxycodone and visceral pain were identified and reviewed. Additionally, 5 basic research studies that contributed to our knowledge of the specific mechanisms of action of oxycodone were also reviewed. Finally, recent evidence-based reviews of RCTs on neuropathic pain were selected (6 reviews), and specific RCTs on neuropathic cancer pain were also identified (2 trials). The review of the literature shows that the management of neuropathic cancer pain has changed dramatically in the last few years thanks to new approaches and novel drugs. The vast majority of these new drugs have been proven to be useful in ‘benign’ neuropathic pain syndromes. The intrinsic difficulties in performing RCTs in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign neuropathic pain, in spite of insufficient evidence in malignant neuropathic pain. Therefore, a case is made for the development of specific guidelines for the management of both simple and complex cases of neuropathic cancer pain. An example of one of such clinical guidelines is provided, in which the role of oxycodone is particularly relevant given the existing evidence.

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“…However, none could be identified by Maier et al [44]. In 2006, Riley et al [7] introduced a clinically objective model for predicting switchers (patients not responding to morphine who should be switched to other opioids or other analgesic treatments). They stated that the model was in its infancy and had no use in clinical practice in the presented form and needed further development by the addition of genetic and immunological data.…”

Section: Discussionmentioning

confidence: 99%

“…This approach has been used to identify common alterations in the EPs for a group of subjects after drug administration in comparison to pretreatment or placebo recordings [6]. However, the study of group alterations is a crude approximation when describing the mechanisms of action for analgesics, since it is well known that individuals display a large variation in efficacy to analgesics such as opioids [7]. Hence, new methods to quantify individual alterations in the EPs are warranted.…”

Section: Introductionmentioning

confidence: 99%

Multivariate Analysis of Single-Sweep Evoked Brain Potentials for Pharmaco-Electroencephalography

Graversen¹,

Olesen²,

Staahl³

et al. 2015

Neuropsychobiology

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Background and Aims: Current findings on altered evoked potentials (EPs) caused by morphine are based on common alterations for a group of subjects after drug administration. However, this ignores the analysis of individual responses, which may explain the clinical differences in efficacy. Therefore, we explored the individual responses to morphine in terms of the altered single-sweep characteristics in a placebo-controlled crossover study. To account for multifactorial mechanisms, several characteristics were assessed simultaneously by multivariate pattern analysis (MVPA). Methods: EPs were recorded from 62 channels and obtained before and after morphine and placebo administration during repeated electrical stimulations of the oesophagus in 12 healthy males. Additionally, the pain detection threshold was recorded to reflect the subjective analgesic effect in each subject. The characteristics of the sweeps were extracted by a multivariate matching pursuit algorithm with Gabor atoms implemented with a variable amplitude and constant phase across the sweeps. The single-sweep amplitudes were used as input to an MVPA algorithm to discriminate individual responses. The accuracy of the MVPA for each individual subject was used for correlation analysis of the analgesic effect. Results: The mean classification accuracy when discriminating pre- and posttreatment morphine responses was 72% (p = 0.01). The individual classification accuracy was positively correlated to the analgesic effect of morphine (p = 0.03). Furthermore, the 2 posttreatment responses were classified and validated by the classification of the 2 pretreatment responses (p = 0.001). Conclusions: The alterations in the single-sweep EPs after morphine reflect the analgesic effect. The MVPA approach is a novel methodology for monitoring the individual efficacy of analgesics.

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No pain relief from morphine?

Abstract: This study has shown that proactive clinical identification and management of patients that require opioid switching is reproducible in different clinical settings and significantly improves pain control. Further studies are required to develop and test the predictive model.

Cited by 112 publications

References 19 publications

Neuropathic Pain – The Case for Opioid Therapy

Neuropathic Pain – The Case for Opioid Therapy

Oxycodone and the Challenge of Neuropathic Cancer Pain: A Review

Multivariate Analysis of Single-Sweep Evoked Brain Potentials for Pharmaco-Electroencephalography

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