| Passik1313 Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84(7):593-601.
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Assess long-term opioid therapy, including unmet needs, risks, and solutions |
Literature review |
Opioids |
Chronic pain and abuse of prescribed opioids are common and substantially affect patients, doctors, and the society. Aggressive treatment of chronic pain should be balanced with the need to minimize the risks of opioid abuse, misuse, and deviation. |
| Wilson et al.1111 Wilson KG, Chochinov HM, Allard P, Chary S, Gagnon PR, Macmillan K, et al. Prevalence and correlates of pain in the Canadian National Palliative Care Survey. Pain Res Manag. 2009;14(5):365-70.
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Examine the prevalence of pain, its perceived severity, and its correlation across a range of physical, social, psychological, and existential symptoms. |
Multicenter study addressing cancer patients' pain and assessing 21 other symptoms and concerns |
|
Continued pain is a problem for many cancer patients under palliative care, especially in younger individuals approaching death |
| Paice and Ferrell88 Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011;61(3):157-82.
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Review available pain management treatments considering the individual needs of patients as well as special populations, including the elderly, cancer survivors, patients with addictive diseases, and those at the end of life. |
|
|
The urgent need to address cancer pain issues emerged in oncology in the 1970s, largely influenced by the introduction of palliative care (PC). PC providers demonstrated that pain could be relieved, and failure to do so meant the decreased quality of life. Over the past 30 years, cancer pain relief has become a priority in oncology. Despite significant advances, there are still continuing barriers to quality of care and pain relief. There are many resources to assist doctors in treating cancer pain. |
| Rangel and Telles55 Rangel O, Telles C. Tratamento da dor oncológica em cuidados paliativos. Rev Hosp Universit Pedro Ernesto. 2012;11:32-7.
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Address the principles for cancer pain treatment, as well as barriers related to patients, health professionals, and the health system. |
Literature review |
|
All physicians should be familiar with the use of analgesics. Opioids should not be prescribed just because the patient has a fatal disease, but according to the intensity of his/her pain. |
| Hennemann- Krause1414 Hennemann-Krause L. Aspectos práticos da prescrição de analgésicos na dor do câncer. Rev Hosp Universit Pedro Ernesto. 2012;11:38-49.
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Present the rational use of analgesic drugs, highlighting their indications, doses, adverse effects, and proper care for the adequate prescription of common analgesics and opioids for the control of chronic cancer pain. |
Literature review |
Common analgesic drugs and opioids |
Opioids prescription should not be done because the patient has a fatal disease, but according to the intensity of the pain. |
| Madadi et al.1515 Madadi P, Hildebrandt D, Lauwers AE, Koren G. Characteristics of opioid-users whose death was related to opioid-toxicity: a population-based study in Ontario, Canada. PLoS One. 2013;8(4):e60600.
|
Identify patterns and characteristics among opioid users |
Qualitative study |
Opioids |
New susceptible groups of opioid users with related cause of death were identified. The first evidence to help quantify the contribution of opioid misuse to user mortality in Canada |
| Srisawang et al.1616 Srisawang P, Harun-Or-Rashid M, Hirosawa T, Sakamoto J. Knowledge, attitudes and barriers of physicians, policy makers/regulators regarding use of opioids for cancer pain management in Thailand. Nagoya J Med Sci. 2013;75:201-12.
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Assess the knowledge and attitudes of physicians and policymakers/regulators regarding the use of opioids for cancer pain management. |
Cross-sectional study |
Opioids |
Continued education for physicians and conference organization is required for policymakers/regulators. Special education and training should be addressed to clarify the terms of physical addiction. |
| Zeppetella1717 Zeppetella G. Fentanyl sublingual spray for breakthrough pain in cancer patients. Pain Ther. 2013;2(1):1-9.
|
Known non-parenteral opioid formulations, such as sublingual fentanyl, which can provide faster and more effective relief from transitory exacerbation cancer pain. |
Systematic review |
Non-parenteral opioids, such as sublingual fentanyl |
Fentanyl formulation available at doses of 100, 200, 400, 600 and 800 µg approved for the treatment of transitory exacerbation pain in opioid therapy tolerant adult cancer patients for underlying persistent cancer pain |
| Kraychete, Siqueira and Garcia1818 Kraychete DC, Siqueira JT, Garcia JB. Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly. Rev Dor. 2014;15(Suppl 1):S65-9.
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Discuss recommendations for opioid use in newborns, children and the elderly |
Systematic review |
Opioids |
The use of opioids at extreme ages is still a challenge. However, continued education around the subject is needed, stimulating clinical research and the creation of evidence-based recommendations. The safe use of these agents in the correct indication and proportion for pain relief decreases risks and should be the basis of sound clinical conduct. |
| Nunes, Garcia and Sakata1919 Nunes BC, Garcia JB, Sakata RK. [Morphine as first medication for treatment of cancer pain]. Braz J Anestesiol. 2014;64(4):236-40. Portuguese. English.
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Assess the use of morphine as the first drug for moderate cancer pain treatment in patients with advanced disease and/or metastasis, as an option to the recommendations of the WHO-recommended analgesic ladder. |
Randomized controlled study |
Morphine |
The use of morphine as the first drug for pain treatment did not promote a better analgesic effect than the WHO-recommended ladder, and there was a higher incidence of adverse effects. |
| Rocha et al.2020 Rocha LS, Beuter M, Neves ET, Leite MT, Brondani MC, Perlini NM. Self-care of elderly cancer patients undergoing outpatient treatment. Texto Contexto Enferm. 2014;23(1):29-37.
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Analyze the self-care of older people living with cancer in outpatient treatment, from the perspective of their autonomy |
Qualitative and descriptive research |
|
The autonomy for self-care of the elderly is manifested in the concern with food, knowledge of the body's limits, changes imposed by living with cancer, and family support. |
| Kim et al.2121 Kim YC, Ahn JS, Calimag MM, Chao TC, Ho KY, Tho LM, et al. Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Med. 2015;4(8):1196-204.
|
Assess pain response to opioid rotation or opioid combination in patients with uncontrolled cancer pain |
Randomized study |
Opioids |
For patients with chronic uncontrolled cancer pain, both opioid rotation and combination strategies appear to provide significant pain relief and better patient satisfaction. |
| Reticena, Beuter and Sales2222 Reticena KO, Beuter M, Sales CA. Vivências de idosos com a dor oncológica: abordagem compreensiva existencial. Rev Esc Enferm USP. 2015;49(3):419-25.
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Understand the experiences of the elderly with cancer pain |
Qualitative research based on Heidegger's phenomenology, with recorded interviews |
|
Cancer pain has biopsychosocial repercussions for the elderly, generating changes in their life activities and requiring holistic and authentic care. |
| Reyes-Gibby, Anderson and Todd66 Reyes-Gibby CC, Anderson KO, Todd KH. Risk for opioid misuse among emergency department cancer patients. Acad Emerg Med. 2016;23(2):151-8.
|
Determine the risk of opioid misuse among emergency services for cancer pain patients and assess the demographic and clinical factors associated with increased risk of opioid abuse. |
A cross-sectional study with a convenience sample |
Opioids |
The risk of opioid misuse among cancer patients is substantial. Tracking misuse in emergency departments is feasible |
| Coluzzi et al.1010 Coluzzi F, Taylor R Jr, Pergolizzi JV Jr, Mattia C, Raffa RB. [Good clinical practice guide for opioids in pain management: the three Ts - titration (trial), tweaking (tailoring), transition (tapering)]. Rev Bras Anestesiol. 2016;66(3):310-7. Portuguese, English.
|
Review some basic principles of opioid analgesia based on experience and knowledge of current publications on this care |
Literature review |
Opioids |
Establish titration, individualization, and gradual reduction, along with the application of other good medical practice and clinical experience/judgment, including non-pharmacological approaches, can assist health care professionals in the effort to achieve optimal pain treatment. |
| Galicia-Castillo1212 Galicia-Castillo M. Opioids for persistent pain in older adults. Cleve Clin J Med. 2016;83(6):443-51.
|
Manage chronic pain safely in the elderly |
Literature review |
|
A complete assessment, including description and management of pain, comorbidities, physical examination, and diagnostic tests are required for patient control. It is also important to inquire about the history of substance abuse. |
| Cella et al.2323 Cella IF, Trindade LCT, Sanvido LV, Skare TL. Prevalence of opiophobia in cancer pain treatment. Rev Dor. 2016;17(4):245-7.
|
Assess the prevalence of pain and opiophobia in cancer patients. |
A cross-sectional study with patients undergoing exclusive cancer clinical treatment in an outpatient cancer hospital |
Opioids |
A high prevalence of moderate to severe pain was found in the observed patients, as well as a high prevalence of opiophobia. |
| Lin et al.2424 Lin CP, Hsu CH, Fu WM, Chen HM, Lee YH, Lai MS, et al. Key opioid prescription concerns in cancer patients: a nationwide study. Acta Anaesthesiol Taiwan. 2016;54(2):51-6.
|
Examine Taiwan's opioid prescribing standards for cancer patients to discover their potential concerns |
Review of claims in the Taiwan National Health Insurance database for cancer-diagnosed patients from 2003 to 2011 |
Opioids |
The use of strong short-acting opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among cancer patients in Taiwan. |
| Oosten et al.2525 Oosten AW, Abrantes JA, Jonsson S, De Bruijn P, Kuip EJM, Falcão A, et al. Treatment with subcutaneous and transdermal fentanyl: Results from a population pharmacokinetic study in cancer patients. Eur J Clin Pharmacol. 2016;72(4):459-67.
|
Study the pharmacokinetics of subcutaneous and transdermal fentanyl and assess relays between subcutaneous and transdermal uses |
Cohort study |
Subcutaneous and transdermal fentanyl |
Absorption may lead to fluctuations in plasma transdermal and subcutaneous fentanyl concentrations. Relay schemes are not applicable for subcutaneous and transdermal fentanyl rotations |
| Reddy et al.2626 Reddy A, Tayjasanant S, Haider A, Heung Y, Wu J, Liu D, et al. The opioid rotation ratio of strong opioids to transdermal fentanyl in cancer patients. Cancer. 2016;122(1):149-56.
|
Determine the relationship between the equivalent daily dose of morphine and the dose of transdermal fentanyl in opioid rotation |
Retrospective study |
Morphine and transdermal fentanyl |
The median rotation rate of transdermal fentanyl for the equivalent daily morphine dose was 100 mg/day and 2.4 µg/h, suggesting that 100 µg/h is equivalent to the 240 mg daily morphine dose. |
| Barbera et al.2727 Barbera L, Sutradhar R, Chu A, Seow H, Howell D, Earle CC, et al. Opioid prescribing among cancer and non-cancer patients: Time trend analysis in the elderly using administrative data. J Pain Symptom Manage. 2017;54(4):484-92.e1.
|
Verify whether opioid prescriptions changed among older adults after 2007, in the context of changing opioid regulations, and whether effects were different among patients with a history of cance |
Elderly patients stratified annually into three groups: no history of cancer, diagnosed with cancer for more than 5 years and diagnosed with cancer for 5 years or less. Trends over time have been assessed per year for 1) opioid prescription rate, comparing trends before and after 2007; 2) average daily dose of opioid |
Opioids |
Decreasing prescription rates have been observed in some drug subclasses. The potential impact of these changes on the quality of symptom control for cancer patients requires further investigation. |
| Bennett, Paice and Wallace2828 Bennett M, Paice JA, Wallace M. Pain and opioids in cancer care: benefits, risks, and alternatives. Am Soc Clin Oncol Educ Book. 2017;37:705-13.
|
Understand the comprehensive management of cancer pain, including a thorough assessment, along with the use of pharmacological, non-pharmacological, integrative, and interventional therapies. |
Literature review |
Pharmacological, non-pharmacological, integrative, and interventional therapies |
Although cancer pain remains prevalent, it remains undertreated, partly due to the concerns about opioid use. Opioids' efficacy in advanced disease is already clearly established; however, there are still issues about opioids' safety and efficacy in long-term cancer survivors. |
| Haider et al.2929 Haider A, Zhukovsky DS, Meng YC, Baidoo J, Tanco KC, Stewart HA, et al. Opioid prescription trends among patients with cancer referred to outpatient palliative care over a 6-year period. J Oncol Pract. 2017;13(12):e972-81.
|
Assess changes in the opioid type and prescription dose among patients who are referred by oncologists to an outpatient palliative care clinic |
Review of electronic patient health records at new CP Outpatient Consultations between January 1 and April 30 of each year from 2010 to 2015. Demographic data, cancer type, and stage, symptom assessment, performance status, opioid data were collected.
Opioid type and dose defined as the equivalent daily dose of morphine |
Opioids |
Over the past few years, the equivalent daily dose of morphine prescribed by reference oncologists has decreased. Following hydrocodone reclassification, the use of tramadol with less stringent prescription limit increased |
| Kuip et al.3030 Kuip EJ, Zandvliet ML, Koolen SL, Mathijssen RH, van der Rijt CC. A review of factors explaining variability in fentanyl pharmacokinetics; focus on implications for cancer patients. Br J Clin Pharmacol. 2017;83:294-313.
|
Summarize the multiple factors studied that potentially influence fentanyl pharmacokinetics focusing on implications for cancer patients |
Systematic review |
Fentanyl |
Although aging may influence the fentanyl pharmacokinetics, sound conclusions are difficult to draw. There is at least a risk of lower clearance and, therefore, greater accumulation in elderly patients. Therefore, fentanyl should be titrated with caution in elderly patients. |
| Lee et al.3131 Lee KH, Kim TW, Kang JH, Kim JS, Ahn JS, Kim SY, et al. Efficacy and safety of controlled-release oxycodone/naloxone versus controlled-release oxycodone in Korean patients with cancer-related pain: a randomized controlled trial. Clin J Cancer. 2017;36(1):74.
|
Assess the non-inferiority of oxycodone/naloxone compared to controlled-release oxycodone for cancer pain control |
Randomized, open, phase IV, parallel-group clinical trial |
Oxycodone/naloxone and oxycodone |
The group receiving oxycodone/naloxone was no lower than the one receiving oxycodone in terms of pain reduction after 4 weeks of treatment and had a similar safety profile. |
| Nosek et al.3232 Nosek K, Leppert W, Nosek H, Wordliczek J, Onichimowski D. A comparison of oral controlled-release morphine and oxycodone with transdermal formulations of buprenorphine and fentanyl in the treatment of severe pain in cancer patients. Drug Des Devel Ther. 2017;11:2409-19.
|
Compare analgesia and adverse effects during oral administration of morphine and oxycodone, transdermal fentanyl and buprenorphine in cancer and pain patients |
Randomized clinical trial |
Morphine, oxycodone, transdermal fentanyl, and buprenorphine |
All opioids were effective and well-tolerated. Morphine was the most effective for pain improvement compared to some of the questionnaire items regarding the negative impact of pain on patients' daily activities. |
| Schmidt-Hansen et al.3333 Schmidt-Hansen M, Bennett MI, Arnold S, Bromham N, Hilgart JS. Oxycodone for cancer-related pain. Cochrane Database Syst Rev. 2017;8:CD003870.
|
Assess the efficacy and tolerability of oxycodone in any pain administration route in adults with cancer. |
Systematic literature review |
Oxycodone |
For clinical purposes, oxycodone or morphine may be used as first-line oral opioids for pain relief in cancer adults. |
| Yen et al.77 Yen TY, Chiou JF, Chiang WY, Su WH, Huang MY, Hu MH, et al. Proportional dose of rapid-onset opioid in breakthrough cancer pain management: An open-label, multicenter study. Medicine. 2018;97(30):e11593.
|
Assess the efficacy and safety of proportional doses of fentanyl oral soluble film in patients with transitory exacerbation cancer pain. |
An open, non-comparative multicenter study |
Fentanyl oral soluble film |
The dose of fentanyl oral soluble film proportional to the opioid regimen for basal pain treatment is effective and well-tolerated for the treatment of patients with transitory exacerbation cancer pain. |
| Guitart et al.3434 Guitart J, Vargas MI, De Sanctis V, Folch J, Salazar R, Fuentes J, et al. Efficacy and safety of sublingual fentanyl tablets in breakthrough cancer pain management according to cancer stage and background opioid medication. Drugs R D. 2018;18(2):119-28.
|
Assess the effect of sublingual fentanyl tablets for pain relief, quality of life and adverse effects in cancer pain patients according to cancer stage and basal opioid regimen |
Qualitative study |
Sublingual fentanyl tablets |
Subgroup exploratory analyses demonstrate the efficacy and safety of sublingual fentanyl tablets for treating transitory exacerbation cancer pain, regardless of cancer stage and basal opioid regimen. |
| Masel et al.3535 Masel EK, Landthaler R, Gneist M, Watzke HH. Fentanyl buccal tablet for breakthrough cancer pain in clinical practice: results of the non-interventional prospective study ErkentNIS. Support Care Cancer. 2018;26(2):491-7.
|
Document the feasibility of fentanyl oral tablets for the treatment of patients with transitory exacerbation cancer pain. |
Prospective study |
Fentanyl oral tablets |
Treatment with fentanyl oral tablets led to quick pain relief and reductions in the number of episodes of transitory exacerbation cancer pain. Patient satisfaction was rated as excellent or good. |
| Peng et al.3636 Peng Z, Zhang Y, Guo J, Guo X, Feng Z. Patient-controlled intravenous analgesia for advanced cancer patients with pain: A retrospective series study. Pain Res Manag. 2018;2018.7323581.
|
Compare the efficacy and adverse effects of patient-controlled intravenous analgesia with hydromorphone, sufentanil, and oxycodone in the treatment of patients with advanced cancer and pain. |
Retrospective serial study |
Patient-controlled intravenous hydromorphone, sufentanil, and oxycodone |
There was no significant difference in analgesic effect and adverse effect between hydromorphone, sufentanil, and oxycodone. |
| Yamada et al.3737 Yamada M, Matsumura C, Jimaru Y, Ueno R, Takahashi K, Yano Y. Effect of continuous pharmacist interventions on pain control and side effect management in outpatients with cancer receiving opioid treatments. Biol Pharm Bull. 2018;41(6):858-63.
|
Assess the effect of continuous pain management interventions and opioid-induced adverse effects on outpatients with cancer |
Systematic review |
Opioids |
Pharmacist interventions can help to adequately achieve the management of pain and adverse effects through interviews and ongoing assessments of cancer patients prior to consultations with physicians, which underlines the importance of pharmacist interventions. |
