Morphine and alternative opioids in cancer pain: the EAPC recommendations
Humans; Analgesics; Drug Administration Schedule; Administration; Oral; Palliative Care/standards; Injections; Intravenous; Subcutaneous; Oxycodone/administration & Pain/drug therapy; Opioid/administration & dosage/adverse effects/therapeutic use; Spinal; Chemistry; Fentanyl/administration & dosage/therapeutic use; Hydromorphone/administration & Infusions; Methadone/pharmacokinetics/therapeutic use; Morphine/administration & Neoplasms/drug therapy; Pharmaceutical
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.
2001
Hanks GW; Conno F; Cherny NI; Hanna M; Kalso E; McQuay HJ; Mercadante S; Meynadier J; Poulain P; Ripamonti C; Radbruch L; Casas JR; Sawe J; Twycross RG; Ventafridda V; Expert Working Group of the Research Network of the European Association for Palliative Care
British Journal Of Cancer
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1054/bjoc.2001.1680" target="_blank" rel="noreferrer">10.1054/bjoc.2001.1680</a>
Quantitative estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use
Humans; Cohort Studies; Death; Disease Progression; Risk Assessment; Non-U.S. Gov't; Research Support; Models; Statistical; Anti-Inflammatory Agents; Databases; Factual; Digestive System; Endoscopy; Gastrointestinal Hemorrhage/chemically induced/mortality; Non-Steroidal/adverse effects; Peptic Ulcer Perforation/chemically induced/mortality
Randomised controlled trials (RCTs) alone are unlikely to provide reliable estimates of the incidence of rare events because of their limited size. Cohort, case control, and other observational studies have large numbers but are vulnerable to various kinds of bias. Wanting to estimate the risk of death from bleeding or perforated gastroduodenal ulcers with chronic usage of non-steroidal anti-inflammatory drugs (NSAIDs) with greater precision, we developed a model to quantify the frequency of rare adverse events which follow a biological progression. The model combined data from both RCTs and observational studies. We searched systematically for any report of chronic (>/=2 months) use of NSAIDs which gave information on gastroduodenal ulcer, bleed or perforation, death due to these complications, or progression from one level of harm to the next. Fifteen RCTs (19364 patients exposed to NSAIDs for 2-60 months), three cohort studies (215076 patients redeeming a NSAID prescription over a 3-12 month period), six case-control studies (2957 cases) and 20 case series (7406), and case reports (4447) were analysed. In RCTs the incidence of bleeding or perforation in 6822 patients exposed to NSAIDs was 0.69%; two deaths occurred. Of 11040 patients with bleeding or perforation with or without NSAID exposure across all reports, 6-16% (average 12%) died; the risk was lowest in RCTs and highest in case reports. Death from bleeding or perforation in all controls not exposed to NSAIDs occurred in 18 out of 849489 (0.002%). From these numbers we calculated the number-needed-to-treat for one patient to die due to gastroduodenal complications with chronic (>/=2 months) NSAIDs as 1/((0.69x inverted question mark6-16%, average 12% inverted question mark)-0.002%))=909-2500 (average 1220). On average 1 in 1200 patients taking NSAIDs for at least 2 months will die from gastroduodenal complications who would not have died had they not taken NSAIDs. This extrapolates to about 2000 deaths each year in the UK.
2000
Tramer MR; Moore RA; Reynolds DJ; McQuay HJ
Pain
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0304-3959(99)00267-5" target="_blank" rel="noreferrer">10.1016/s0304-3959(99)00267-5</a>
Opioids in chronic non-cancer pain: systematic review of efficacy and safety
Humans; Pain Measurement; Analgesics; Treatment Outcome; Methadone; Time Factors; Double-Blind Method; Non-U.S. Gov't; Research Support; Comparative Study; Chronic disease; Pain/drug therapy; Opioid/adverse effects/therapeutic use; Drug Evaluation; Drug Utilization Review; Randomized Controlled Trials/methods
Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. The Oxford Pain Relief Database (1950-1994) and Medline, EMBASE and the Cochrane Library were searched until September 2003. Inclusion criteria were randomised comparisons of WHO step 3 opioids with placebo in chronic non-cancer pain. Double-blind studies reporting on pain intensity outcomes using validated pain scales were included. Fifteen randomised placebo-controlled trials were included. Four investigations with 120 patients studied intravenous opioid testing. Eleven studies (1025 patients) compared oral opioids with placebo for four days to eight weeks. Six of the 15 included trials had an open label follow-up of 6-24 months. The mean decrease in pain intensity in most studies was at least 30% with opioids and was comparable in neuropathic and musculoskeletal pain. About 80% of patients experienced at least one adverse event, with constipation (41%), nausea (32%) and somnolence (29%) being most common. Only 44% of 388 patients on open label treatments were still on opioids after therapy for between 7 and 24 months. The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction.
2004
Kalso E; Edwards JE; Moore RA; McQuay HJ
Pain
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.pain.2004.09.019" target="_blank" rel="noreferrer">10.1016/j.pain.2004.09.019</a>