Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

Kurita, Geana Paula; Kaasa, Stein; Sjøgren, Per

doi:10.1177/0269216310386279

Cited by 25 publications

(14 citation statements)

References 57 publications

(146 reference statements)

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“…Deciding on the use of these interventions requires an estimation of prognosis and an assessment of risks (contraindications to spinal procedures in patients with risk of bleeding, infection, or local tumor burden) compared with the potential benefits in patients whose pain is inadequately managed. Much of the data on outcomes are based on uncontrolled studies; therefore, more studies are needed to evaluate the efficacy and safety of spinal opioids …”

Section: Pain Management: Nonopioidmentioning

confidence: 99%

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Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

258

174

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Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182-196.

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Section: Pain Management: Nonopioidmentioning

confidence: 99%

“…Much of the data on outcomes are based on uncontrolled studies; therefore, more studies are needed to evaluate the efficacy and safety of spinal opioids. 90…”

Section: Interventionsmentioning

confidence: 99%

Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

258

174

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“…14 The review concluded that there are few RCTs and that these are of low quality, generally due to small sample size, variable study design and methodological limitations thus producing weak evidence. They analysed the accumulated incidence data from the uncontrolled trials, and concluded that spinal opioid therapy may be effective for treating cancer pain that has not been adequately controlled by systemic treatment.…”

Section: Cancer Painmentioning

confidence: 99%

Neuraxial (epidural and intrathecal) opioids for intractable pain

Farquhar-Smith

Chapman

2012

British Journal of Pain

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There is an increasing evidence base for the use of neuraxial analgesia for chronic non-malignant pain (CNMP), cancer-related intractable pain and spasticity. Several drugs are available for use including opioids, local anaesthetics and adjuvant drugs such as clonidine and ziconotide. This review will focus mainly on the use of neuraxial opioids for CNMP and cancerrelated pain; a brief description of the action of the other drugs will be provided but not discussed in full. Patient selectionNeuraxial analgesia is considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects. In rare circumstances it may be used for rapid, effective analgesia when there is limited time available for titration of oral or subcutaneous analgesia (e.g. end-of-life palliative care).Exclusion criteria relate specifically to psychological and psychiatric illness, allergy and certain physiological conditions which may be relative or absolute contraindications. If a significant psychological disorder, personality disorder, addictive personality or frank psychiatric illness is detected during the assessment and history-taking process then the patient is not considered suitable. Other exclusion criteria include depression, senility, suspected pain behaviour, alcohol or opioid abuse and poor physical condition. True allergy to any of the proposed analgesic or adjuvant drugs will preclude their use. Absolute contraindications include coagulation defects, local sepsis at the proposed Neuraxial (epidural and intrathecal) opioids for intractable painPaul Farquhar-Smith and Suzanne Chapman Summary Points 1. Neuraxial opioids are considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects. 2. Neuraxial opiods can be considered for both chronic non-malignant pain and chronic cancer-related pain. 3. Effectiveness in chronic non-malignant pain and cancer pain is exerted through the use of either single-agent drugs (opioids) or a combination of drugs: opioids, local anaesthetics and other drugs such as clonodine and ziconotide. 4. Complications of long-term continuous infusion therapy are related to the insertion process (haematoma), the mechanical device (both pump and catheter) and the long-term effects of the drugs. 5. Patients will require ongoing ambulatory monitoring and supportive care.

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“…Using the quality of evidence hierarchy developed by the U.S. Preventive Services Task Force, Patel and coworkers (8) found both level II‐3 and level III evidence supporting the use of IT infusion systems for chronic noncancer pain. Kurita and coworkers (9) performed a systematic review to analyze analgesic efficacy and side‐effects of spinal opioids in adult cancer patients previously treated with systemic opioids. These authors identified nine RCTs, two nonrandomized cohort studies, 28 uncontrolled prospective studies, and five case series evaluating these issues.…”

Section: Concerns Over Efficacymentioning

confidence: 99%