scholarly journals Compliance with Opioid Therapy: Distinguishing Clinical Characteristics and Demographics Among Patients with Cancer Pain

Pain Medicine ◽  
2017 ◽  
Vol 19 (7) ◽  
pp. 1469-1477 ◽  
Author(s):  
Dhanalakshmi Koyyalagunta ◽  
Eduardo Bruera ◽  
Mitchell P Engle ◽  
Larry Driver ◽  
Wenli Dong ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Clinical Characteristics ◽  
Opioid Therapy ◽  
Patients With Cancer

scholarly journals Prospective Association of Serum Opioid Levels and Clinical Outcomes in Patients With Cancer Pain Treated With Intrathecal Opioid Therapy

2020 ◽  
Vol 130 (4) ◽  
pp. 1035-1044 ◽  
Author(s):  
Shane E. Brogan ◽  
Jill E. Sindt ◽  
Carina M. Jackman ◽  
Julia White ◽  
Victoria Wilding ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Patients With Cancer ◽  
Prospective Association

Role of Intravenous Ketamine as Adjuvant to Opioids in Refractory Cancer Pain: Case Report

2019 ◽  
Vol 3 (1) ◽  
pp. 49-53
Author(s):  
Yogesh Regmi ◽  
Ganga Sapkota ◽  
Bhawna Wagle
Keyword(s):  
Cancer Pain ◽  
Tissue Injury ◽  
Case Reports ◽  
Opioid Analgesics ◽  
Nmda Receptor Antagonist ◽  
Opioid Therapy ◽  
Chronic Stimulation ◽  
Patients With Cancer ◽  
Nociceptive Input

Cancer pain is caused by continuous tissue injury, which may be due to surgery, infiltration of the surrounding organs including nerves, as well as from mucositis after chemo- or radiotherapy. The pain experienced by cancer patients needs a multimodal approach, including ketamine. Nerve involvement, chronic opioid therapy and continuous nociceptive input cause hyperalgesia. Chronic stimulation of the dorsal root neurons leads to hyperalgesia and resistance (tolerance) to μ opioid analgesics (hyperalgesia-tolerance). The NMDA receptor antagonist ketamine reverses tolerance to morphine. The management of cancer patient’s pain with ketamine as an adjuvant to opioids is presented in case reports of two patients with cancer-related neuropathic pain, in which pain proved untreatable with the usual conventional pain therapies. Ketamine was administered IV route, in addition to morphine and the pain was controlled successfully in these patients. No side-effects were noted except drowsiness which responded to a reduction in the opioids dose.  

scholarly journals Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J Study): A Post Hoc Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4193
Author(s):  
Akihiro Tokoro ◽  
Hisao Imai ◽  
Soichi Fumita ◽  
Toshiyuki Harada ◽  
Toshio Noriyuki ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Treatment ◽  
Bowel Function ◽  
Opioid Therapy ◽  
Pain Patient ◽  
Post Hoc Analysis ◽  
Patients With Cancer ◽  
Bowel Movements ◽  
Ecog Ps ◽  
Post Hoc

Opioid-induced constipation (OIC) can limit the clinical benefit of opioid treatment. This post-hoc analysis evaluated the association between the Rome IV diagnostic criteria and other measures for OIC, including the Bowel Function Index (BFI), correlation between demographics and OIC onset, impact of OIC on pain treatment, and impact of patient–healthcare professional (HCP) communication on patient satisfaction. Patients recorded bowel habits in paper diaries for 14 days following opioid initiation. Study-specific questionnaires were used to evaluate patient awareness of OIC and satisfaction. Patients were ≥20 years old, initiating strong opioid therapy for cancer pain, had an ECOG PS ≤ 2, and had no constipation (≥3 bowel movements within 7 days of enrollment). A total of 220 patients were enrolled. The sensitivity and specificity of BFI for identifying OIC were 81.2% and 54.7%, respectively. Age <65 versus ≥65 years (odds ratio (OR) = 0.510, 95% confidence interval (CI): 0.267–0.977) and the presence or absence of comorbidities (OR = 0.443, 95% CI: 0.221–0.885) were correlated with OIC onset. The proportion of inpatients with sustainable pain control at week 2 was similar in patients with or without OIC (60.0% vs. 67.2%, respectively). By patient assessment, there was a significant correlation between an adequate level of patient–HCP communication and satisfaction with OIC treatment (OR = 9.538 (95% CI: 1.577–57.681)). Using BFI to screen for OIC represents a valid approach in patients with cancer pain. Patient–HCP communication is essential for effective management of OIC in patients with cancer pain.

Sublingual Fentanyl (Abstral®) for Breakthrough Cancer Pain

2009 ◽  
Vol 05 (01) ◽  
pp. 10
Author(s):  
Giovambattista Zeppetella ◽  
Keyword(s):  
Cancer Pain ◽  
Effective Dose ◽  
Rescue Medication ◽  
Breakthrough Pain ◽  
Opioid Therapy ◽  
Pharmacological Management ◽  
Patients With Cancer ◽  
The Individual ◽  
Sublingual Fentanyl ◽  
Valuable Role

The sublingual fentanyl tablet is indicated for the management of breakthrough pain in patients with cancer who are already receiving opioid therapy for their background cancer pain. The pharmacokinetic, efficacy, tolerability and safety profile of the sublingual fentanyl tablet suggests that it has a valuable role to play in the symptomatic pharmacological management of breakthrough pain. The effective dose of the sublingual fentanyl tablet cannot be predicted from previous around-the-clock (ATC) or rescue medication; therefore, titration is required to determine the effective dose according to the needs of the individual patient.

scholarly journals Opioids in Cancer Pain: Right or Privilege?

2017 ◽  
Vol 13 (9) ◽  
pp. e809-e814 ◽  
Author(s):  
Leanne K. Jackson ◽  
Syed N. Imam ◽  
Ursula K. Braun
Keyword(s):  
Substance Abuse ◽  
Palliative Care ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Care Physician ◽  
Substance Abuse Disorder ◽  
Ethical Challenges ◽  
Ethical Considerations ◽  
Patients With Cancer ◽  
Palliative Care Setting

Opioid analgesia is a mainstay of the treatment of cancer pain. Treatment of pain in patients with cancer with an ongoing substance abuse disorder can be difficult. We report the ethical challenges of treating a patient with cancer with a concomitant substance abuse disorder in an outpatient palliative care setting. We present an analysis of ethical considerations for the palliative care physician and strategies to aid in the successful treatment of such patients. We argue that there are select patients with cancer for whom exclusion from treatment with opioid therapy is warranted if their health is endangered by prescription of these medications.

scholarly journals Framing of the opioid problem in cancer pain management in Canada

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
R. Asthana ◽  
S. Goodall ◽  
J. Lau ◽  
C. Zimmermann ◽  
P. L. Diaz ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Position Paper ◽  
Chronic Pain Management ◽  
Opioid Use ◽  
Cancer Pain Management ◽  
Canadian Guideline ◽  
Patients With Cancer

Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain.     The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.

Opioid utilization patterns among patients with cancer and noncancer pain.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 194-194
Author(s):  
Catherine J. Datto ◽  
Yiqun Hu ◽  
Eric Wittbrodt ◽  
Perry G. Fine
Keyword(s):  
Cancer Pain ◽  
Dose Escalation ◽  
Index Date ◽  
Opioid Therapy ◽  
Administrative Claims ◽  
Opioid Use ◽  
Medical Claim ◽  
Opioid Dose ◽  
Patients With Cancer ◽  
Utilization Patterns

194 Background: Opioids are used to manage moderate to severe pain in patients with cancer and non-cancer pain. Limited data exist comparing opioid utilization patterns between these two patient populations. Methods: This retrospective, commercial administrative claims database analysis (HealthCore Integrated Research Environment) investigated opioid use patterns, including opioid dose escalation, in adult patients with cancer-related (CP) and non-cancer-related pain (NCP). Adults (age ≥18 years) with at least one pharmacy claim for an opioid between July 1, 2006, and September 30, 2014, were identified (index date). Patients selected for analysis had to have continuous plan eligibility for 6 months pre- and 12 months post-index date and opioid use for at least 4 weeks. Patients with opioid use related to cancer pain were identified by a medical claim for a cancer diagnosis coded within 30 days prior to the index opioid date. Results: A total of 9,209 patients with CP and 409,703 patients with NCP were analyzed. Patients with CP were older than patients with NCP (mean [SD]: 62.6 [12.9] yrs vs. 49.3 [15.3] yrs); other demographics were similar between cohorts. The most common cancer diagnoses were breast, lung, and prostate. Hydrocodone was the most common opioid prescribed for both cohorts. Total mean (SD) days of opioid therapy were 167.1 (341.8) for CP and 196.6 (421.1) for NCP, with similar rates of opioid use for ≥1 year (10.6% for CP; 13.6% for NCP). Median index opioid doses were consistent between the cohorts (CP: 51.7 morphine-equivalent units (MEU); NCP: 45.0 MEU). Median post-index (after the first 30 days) opioid doses were also similar (CP: 55.8 MEU; NCP: 45.3 MEU). Post-index opioid dose reductions occurred in approximately one-third of both cohorts. Opioid dose escalations (up to dose doubling) occurred in 31.8% of CP and 28.3% of NCP patients. More patients died during the follow-up period in the CP cohort (24.1%) compared with the NCP cohort (0.02%). Conclusions: The use of opioids bears many similarities between patients with cancer pain and non-cancer pain, including clinically similar rates of chronic opioid utilization and dose escalation. This study was supported by AstraZeneca.

Controlled-release oxycodone tablets after transdermal-based opioid therapy in patients with cancer and non-cancer pain

2011 ◽  
Vol 23 (5-6) ◽  
pp. 328-332 ◽  
Author(s):  
Enrico Ravera ◽  
Salvatore Di Santo ◽  
Rosa Bosco ◽  
Claudio Arboscello ◽  
Renato Chiarlone
Keyword(s):  
Controlled Release ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Patients With Cancer
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