Sustained‐release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management

Mercadante, Sebastiano; Porzio, Giampiero; Ferrera, Patrizia; Fulfaro, Fabio; Aielli, Federica; Verna, Lucilla; Villari, Patrizia; Ficorella, Corrado; Gebbia, Vittorio; Riina, Salvatore; Casuccio, Alessandra; Mangione, Salvatore

doi:10.1016/j.ejpain.2008.01.013

Cited by 124 publications

(86 citation statements)

References 30 publications

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“…It might or might not be associated with a risk for the abstinence syndrome (physical dependence) or tolerance (loss of drug both, the isolated active isomer (levomethadone) and the racemate is available [28]. It is relatively cheap and lacks active metabolites, which may be favorable in renal impairment [23,[29][30][31]. Due to the inhibition of the central monamino re-uptake and its N-methyl-d-asparate (NMDA) antagonism, pain specialists assume a favorable role for patients with neuropathic pain or opioid tolerance.…”

Section: Addiction and Drug Abusementioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

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Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).

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Section: Addiction and Drug Abusementioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

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“…Methadone is often a second-or third-line opioid for chronic pain syndromes in which side effects of other opioids therapies cannot be tolerated or when a less expensive medication is desired. In many settings, methadone has been shown to be as ef fi cacious as long-acting morphine or fentanyl transdermal systems [ 9 ] . Additionally, methadone has been used successfully in a variety of pain syndromes including neuropathic and cancer-related pain.…”

Section: Clinical Issuesmentioning

confidence: 99%

Methadone for Chronic Pain

Singh

Fishman

Tokarz

2012

Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches

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“…Konstipasyonun uygun diyet ve ilaçlarla tedavi edilebileceği, opioidlerin ağrılı bireylerde alışkanlık yapmayacağı konusunda hasta ve hasta yakınları bilgilendirilmelidir (21,22) . Daha önce opioid almamış kişilerde bulantı-kusma ve kaşıntı yakınması gelişebilir bu nedenle antiemetik kullanı-mı önerilebilir (23,24) .…”

Section: Ağrıunclassified