Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain.

Bruera, Éduardo; Belzile, Michelle; Pituskin, Edith; Fainsinger, Robin L.; Darke, Andrew C.; Harsanyi, Zoltan; Babul, Najib; Ford, I.

doi:10.1200/jco.1998.16.10.3222

Cited by 195 publications

(113 citation statements)

References 39 publications

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“…Oxycodone is similar to morphine in terms of analgesia and adverse effects (Kalso and Vainio, 1990;Hanks and Hawkins, 2000). Because of its better systemic availability (about 60-90%) the equianalgesic dose of oral oxycodone is between half and two-thirds that of oral morphine (Bruera et al, 1998).…”

Section: Intravenous Infusion Of Morphine May Bementioning

confidence: 99%

Morphine and alternative opioids in cancer pain: the EAPC recommendations

et al. 2001

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Summary An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated. http://www.bjcancer.com Daytime drowsiness, dizziness or mental clouding commonly occur at the start of treatment but resolve when patients are stabilized (usually within a few days). For most patients receiving stable doses of morphine effects on cognitive and psychomotor function are minimal. In particular, there are data indicating that patients' driving ability is not significantly impaired, in alert patients receiving a stable dose (Vainio et al, 1995). Similarly, nausea and vomiting, which occur in up to two-thirds of patients when morphine is started, usually resolve. The main continuing adverse effect from morphine is constipation, and the prophylactic use of a laxative is almost always required. Morphine: limitationsThe systemic availability of morphine by the oral route is poor (20-30%) and this contributes to a sometimes unpredictable onset of action and great interindividual variability in dose requirements and response (Glare and Walsh, 1991). Active metabolites may contribute to toxicity, particularly in patients with renal impairment (McQuay and Moore, 1997). And some types of pain do not always respond well or completely to morphine, notably neuropathic pain. However, none of the alternatives to morphine has so far demonstrated advantages which would make it preferable as the first line oral opioid for cancer pain. Morphine remains our first choice but for reasons of familiarity, availability and cost rather than proven superiority.2. The optimal route of administration of morphine is by mouth. Ideally, two types of formulation are required: normal release (for dose titration) and modified release (for maintenance treatment) CThe oral route is the simplest and most acceptable to patients.There is large interindividual variation in kinetics (Säwe, 1986) and dynamics in cancer patients whose pain will also vary in severity so that the dose must be titrated against effect for each patient, and the starting dose will be determined by previous analgesic treatment. Patients changing from regular administration of a step 2 opioid (in combination with a non-opioid) will usually start with 10 mg every 4 hours. If step 2 of the analgesic ladder is omitted 5 mg every 4 hours may suffice, whereas patients converted from another step 3 opioid will require more. During dose titration it is preferable to use a formulation of morphine that has a rapid onset and a short duration of action to allow steady state to be achieved as quic...

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Section: Intravenous Infusion Of Morphine May Bementioning

confidence: 99%

Morphine and alternative opioids in cancer pain: the EAPC recommendations

et al. 2001

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“…In two of these (Deschamps et al, 1992;Stambaugh et al, 2001), the description was restricted to the location of the pain. Five trials (Hays et al, 1994;Bruera et al, 1996Bruera et al, , 1998Bruera et al, , 2004Hagen and Babul, 1997) evaluated patients using the Edmonton staging system which classifies pain as visceral, Kaplan et al (1998) 180 (M) Parallel group 6 days 16 (9%) VRSpi 4 11 0/spontaneous report of nervousness, anxiety 20 Klepstad et al (2003) 40 (S) Parallel group p7 days 6 (15%) VASpi; VRSpi 5 11 'Loss of sleep'; HRQOL/HRQOL: ND; sleep data NR 21 Knudsen et al (1985) 18 (S) Crossover 14 days 2 (11%) VASpi 4 10 22 Lauretti et al (2003) 26 (S) Crossover X35 days 4 (11%) VASpi 4 10 23 Melzack et al (1979) 44 (S) Crossover 'About' 4 weeks 14 (32%) PPI 4 9 24 Mignault et al (1995) 19 (S) Crossover 10 days 8 (42%) VASpi; VASpr 4 7 25 Moriarty et al (1999) 100 ( Parris et al (1998) 111 (M) Parallel group 5 days 37 (33%) VRSpi 4 16 29 Portenoy et al (1989) 51 (S) Parallel group Max. 5 days 2 (4%) VRSpi 4 11 'Quality of sleep'/ND 30 Stambaugh et al (2001) 30 (S) Crossover Max.…”

Section: Pain Description and Assessmentmentioning

confidence: 99%

Controlled clinical trials in cancer pain. How controlled should they be? A qualitative systematic review

et al. 2006

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“…Large, randomized, controlled trials have not been done to directly compare opioids, and smaller individual trials are underpowered to demonstrate superiority of one opioid over another [14][15][16][17][18][19]. In addition, studies involving more recently available opioids have been undertaken in mainly noncancer populations.…”

Section: Evidence-based Rationale For Switching: Clinical Trialsmentioning

confidence: 99%

“…Drug company trials have focused on acute and/or nonmalignant pain [12,13], such as chronic back pain, and care should be taken when extrapolating data from those trials to support use in patients with cancer who, by nature, are less well and often taking multiple concomitant medications. To date, large RCTs have not been undertaken to directly compare opioids for cancer-related pain, and smaller individual trials are underpowered to demonstrate superiority of one opioid over another [14][15][16][17][18][19]. Therefore, www.TheOncologist.com the decision by both the WHO and the European Association for Palliative Care (EAPC) to recommend morphine as the opioid of choice is based largely on clinical expertise and pragmatic reasons, such as the general availability of morphine sulphate worldwide and the considerable clinical experience in using this drug.…”

Section: Evidence-based Rationale For Switching: Clinical Trialsmentioning

confidence: 99%

Clinical Pharmacology and Pharmacotherapy of Opioid Switching in Cancer Patients

Ross¹,

Riley²,

Quigley³

et al. 2006

The Oncologist

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Pain is one of the most common and often most feared symptoms in patients with cancer. Ongoing or progressive pain is physically debilitating and has a marked impact on quality of life. Since a third of the population will die from cancer, and of these, 80% will experience severe pain in their final year of life, effective treatment of cancer-related pain remains both a high priority and an ongoing challenge in clinical practice. Individuals with moderate to severe cancer-related pain require treatment with strong analgesics, namely opioids.There is evidence to support the therapeutic maneuver of opioid switching in clinical practice, but further evidence is needed to elucidate the underlying mechanisms for interindividual differences in response to different opioids. Large, robust clinical trials will be needed if clinical differences among side-effect profiles of different opioids are to be clearly demonstrated. This review discusses candidate genes, which contribute to opioid response; many other genes have also been implicated in "pain" from animal or human studies. In order to continue to evaluate the genetic contributions to both pain susceptibility and analgesic response, further candidate genes need to be considered. Good pain control remains a high priority for clinicians and patients, and there is much work to be done to further individualize analgesic therapy for patients with cancer.

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Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain.

Abstract: Controlled-release oxycodone is as safe and effective as controlled-release morphine in the treatment of cancer pain.

Cited by 195 publications

References 39 publications

Morphine and alternative opioids in cancer pain: the EAPC recommendations

Morphine and alternative opioids in cancer pain: the EAPC recommendations

Controlled clinical trials in cancer pain. How controlled should they be? A qualitative systematic review

Clinical Pharmacology and Pharmacotherapy of Opioid Switching in Cancer Patients

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