Optimization of opioid utility in cancer pain populations

Wong, Stanley Sau-Ching; Cheung, Chun

doi:10.21037/apm.2020.03.04

Cited by 8 publications

(6 citation statements)

References 81 publications

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“…Given their strong analgesic effects, opioids are widely used in perioperative analgesia and treatment of postoperative pain and chronic cancer pain. 43,44 Opioid receptors are located in both neurons and immune cells; further, they can be present in several tumor cell types. 45 Opioid promotion of tumor metastasis is intricately associated with the role of μ receptors.…”

Section: Opioidsmentioning

confidence: 99%

<p>Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors</p>

Fan¹,

Wang²,

Chen³

et al. 2020

CMAR

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It is difficult to control the recurrence and metastasis of malignant tumors; furthermore, anesthesia is considered one of the main influencing factors. There has been increasing clinical attention on the effects of anesthetic drugs and methods on postoperative tumor growth and metastasis. We reviewed the effects of anesthesia on tumor recurrence and metastasis; specifically, the effects of anesthetic agents, anesthesia methods, and related factors during the perioperative period on the tumor growth and metastasis were analyzed. This study can provide reference standards for rational anesthesia formulations and cancerrelated pain analgesia protocols for surgical procedures in patients with malignant tumors. Moreover, it contributes toward an experimental basis for the improvement and development of novel anesthetic agents and methods.

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Section: Opioidsmentioning

confidence: 99%

<p>Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors</p>

Fan¹,

Wang²,

Chen³

et al. 2020

CMAR

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“…However, the effective dosages of opioids for pain relief vary significantly from person to person. Opioid titration is the best way to achieve a balance of pain relief and tolerable side effects (2). According to the 2012 European Association for Palliative Care (EAPC) guidelines for the use of opioid analgesics to treat cancer pain, immediaterelease or sustained-release oral morphine and oxycodone can be used for opioid titration, and immediate-release opioids should be given as needed as a supplementary medicine to treat breakthrough pain (BTP) (3,4).…”

Section: Introductionmentioning

confidence: 99%

A 12-hour rapid titration method for cancer pain: a randomized, controlled, open-label study

et al. 2021

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Background: Opioid titration is the best way to achieve a balance of pain relief and tolerable side effects for moderate-to-severe cancer pain. Rapid dose titration helps to achieve early analgesia. We explored the efficacy and safety of a 12-hour rapid dose titration in treating cancer pain.Methods: Opioid-naïve patients with moderate-to-severe cancer pain were randomly divided into oxycodone group and morphine group. The medicines were adjusted to oxycodone sustained-release tablets after 12 hours, and the dose of oxycodone sustained-release tablets was adjusted every 12 hours. The analgesic efficacy and adverse reactions during the treatment were observed until the 72nd hour.Results: A total of 106 patients were included in the analysis, with 51 patients in the oxycodone group and 55 in the morphine group. The pain control rate of all patients reached 96.2% 24 hours after treatment, and it was not significantly different between two groups (P=0.619). The proportion of Numeric Rating Scale (NRS) score that decreased by ≥50% was significantly higher in the oxycodone group than in the morphine group (P=0.013). In the first 12 hours and 24 hours, significantly lower proportions of patients in the oxycodone group experienced multiple episodes of breakthrough pain (BTP) than in the morphine group (P=0.032, P=0.021, respectively). The quality of life of the patients in the oxycodone group was significantly higher than that in the morphine group at the 24th hour (P=0.047), as was the degree to which the quality of life had improved (P<0.001). Only grade 1 or 2 adverse reactions were observed during the study period, and no significant difference between two groups. Conclusions:The 12-hour rapid dose titration method can achieve early analgesia, with mild adverse reactions. In particular, the rapid titration method with background sustained-release oxycodone can reduce BTP episodes and achieve significant early pain relief.

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“…Cancer patients may experience pain related to the disease itself, treatment, or from other comorbidities [ 16 ]. Opioid therapy is the backbone in managing moderate-to-severe cancer-related pain [ 13 , 17 ]. Therefore, clinicians caring for cancer patients must recognize that the challenges associated with opioid use and misuse, seen in the general population, are also present in this cohort.…”

Section: Introductionmentioning

confidence: 99%

Pain Management in Oncology Patients Amidst the Opioid Epidemic: How To Minimize Non-Medical Opioid Use

Chahin¹,

Matosz²,

Khalel³

et al. 2021

Cureus

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The opioid epidemic continues to be a significant public health concern. On the surface, it appears difficult to understate the profound consequences and unnecessary loss of life at the hands of the opioid crisis throughout the 2010s. This reality should not dissuade rigorous attention toward those who have suffered unnecessarily due to an overreaching backlash toward the opioid crisis. Oncology patients have been significantly impacted on both ends of the opioid crisis. Like other populations, cancer patients were first affected during the initial surge of opioid availability, prescription, and use at the beginning of the crisis, where opioid abuse and overdose negatively impacted cancer patient populations at similar rates as the general population. Yet, cancer patients were perhaps even more heavily affected during secondary events after the initial crisis, as opioid restrictions and the stigmatization, undoubtedly beneficial in many spaces, of opioid use became prevalent across the American society. During this second period of the opioid crisis (loosely from 2013 to the present day after the Veterans Health Administration Opioid Safety Initiative started), restrictions on opioids have significantly decreased the use and access of opioids for cancer patients. Management of pain, in general, is a complex topic, and cancer pain is no exception. Cancer patients may experience pain related to the disease itself, its treatment, or other comorbidities. This review aims to clarify the impact of reducing opioid use on cancer patients over the past eight years. We summarize the challenges facing providers as they attempt to manage cancer-related pain. Additionally, we propose tools for best practices to reduce the unnecessary suffering of cancer patients and protect against the overuse and abuse of opioids.

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Optimization of opioid utility in cancer pain populations

Cited by 8 publications

References 81 publications

<p>Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors</p>

<p>Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors</p>

A 12-hour rapid titration method for cancer pain: a randomized, controlled, open-label study

Pain Management in Oncology Patients Amidst the Opioid Epidemic: How To Minimize Non-Medical Opioid Use

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