Relationship between Pain Scores and EORTC QLQ-C15-PAL Scores in Outpatients with Cancer Pain Receiving Opioid Therapy

Background. Acute onset pain is one of the common reasons for cancer patients to present to the emergency department. In our study, we compared painkillers used in cancer patients admitted to the emergency department with pain complaints and their effectiveness and the superiorities of these painkillers in pain relief and their superiorities over each other. Materials and methods. The pain scores of the patients were asked at the time of admission by showing a visual analogue scale. Before treatment, pain scores were recorded. The patients were divided into four different groups according to the type of given treatment: non-steroidal anti-inflammatory drugs; opioid painkillers; paracetamol; paracetamol and opioid therapy. After the treatment, we asked which painkiller written in the treatment form was administered to the patient and recorded the pain score. Results. It was observed that the median pain score before and after treatment of the patients in all painkiller groups differed statically. When the median scores before and after treatment were compared according to drug types, no difference was found between the decrease in pain scores (p = 0.956 and p = 0.705, respectively). It was concluded that the pre-treatment and post-treatment median pain scores of patients who are using non-steroid anti-inflammatory drugs and opioids at home did not differ statistically (p = 0.063). Conclusions. The use of non-steroidal anti-inflammatory drugs, paracetamol or opioids was not found to be superior to each other in patients with acute severe cancer pain.

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Impact of individualized management of breakthrough cancer pain on quality of life in advanced cancer patients: CAVIDIOPAL study

Supportive Care in Cancer ◽

10.1007/s00520-021-06006-1 ◽

2021 ◽

Author(s):

Albert Tuca Rodríguez ◽

Miguel Núñez Viejo ◽

Pablo Maradey ◽

Jaume Canal-Sotelo ◽

Plácido Guardia Mancilla ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Pain ◽

Advanced Cancer ◽

Low Doses ◽

Breakthrough Cancer Pain ◽

Eortc Qlq C30 ◽

Eortc Qlq ◽

Individualized Management ◽

The Impact

Abstract Purpose The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. Methods A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. Results Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001–1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227–13.873). Conclusion Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. Trial registration This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

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Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain

Pain ◽

10.1016/j.pain.2010.02.037 ◽

2010 ◽

Vol 149 (2) ◽

pp. 345-353 ◽

Cited By ~ 82

Author(s):

Mark D. Sullivan ◽

Michael Von Korff ◽

Caleb Banta-Green ◽

Joseph O. Merrill ◽

Kathleen Saunders

Keyword(s):

Cancer Pain ◽

Opioid Therapy ◽

Chronic Opioid Therapy

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Identifying appropriate outcomes to help evaluate the impact of the Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain

10.21203/rs.2.9200/v3 ◽

2019 ◽

Author(s):

Michael Allen ◽

Beth Sproule ◽

Peter MacDougall ◽

Andrea Furlan ◽

Laura Murphy ◽

...

Keyword(s):

Cancer Pain ◽

Patient Outcomes ◽

Opioid Therapy ◽

Data Sources ◽

Prescription Opioid ◽

Advisory Group ◽

Opioid Overdose ◽

Canadian Guideline ◽

Effective Use ◽

The Impact

Abstract Background: The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes . Methods: A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes. Results: Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases. Conclusion: Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.

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A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/91 ◽

2011 ◽

Vol 3;14 (2;3) ◽

pp. 91-121

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Systematic Reviews ◽

Randomized Trials ◽

Opioid Therapy ◽

Functional Improvement ◽

Controlled Trials ◽

Chronic Opioid Therapy ◽

Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

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Muscle function following testosterone replacement in men on opioid therapy for chronic non‐cancer pain ‐ a randomized controlled trial

Andrology ◽

10.1111/andr.13147 ◽

2021 ◽

Author(s):

Mikkel Iwanoff Kolind ◽

Louise Lehmann Christensen ◽

Paolo Caserotti ◽

Marianne Skovsager Andersen ◽

Dorte Glintborg

Keyword(s):

Randomized Controlled Trial ◽

Cancer Pain ◽

Muscle Function ◽

Controlled Trial ◽

Opioid Therapy ◽

Testosterone Replacement ◽

Randomized Controlled

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Cancer Pain Management, Principles of Opioid Therapy, Dosing Guidelines

Encyclopedia of Pain ◽

10.1007/978-3-642-28753-4_540 ◽

2013 ◽

pp. 390-392

Author(s):

James F. Cleary

Keyword(s):

Pain Management ◽

Cancer Pain ◽

Opioid Therapy ◽

Cancer Pain Management

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Random urine drug testing among patients receiving opioid therapy for cancer pain

Cancer ◽

10.1002/cncr.33326 ◽

2020 ◽

Author(s):

Joseph A. Arthur ◽

Michael Tang ◽

Zhanni Lu ◽

David Hui ◽

Kristy Nguyen ◽

...

Keyword(s):

Cancer Pain ◽

Drug Testing ◽

Opioid Therapy ◽

Urine Drug Testing ◽

Urine Drug

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Geographic Variation in Health Service Use and Perceived Access Barriers for Australian Adults with Chronic Non-Cancer Pain Receiving Opioid Therapy

Pain Medicine ◽

10.1093/pm/pnw109 ◽

2016 ◽

Vol 17 (11) ◽

pp. 2003-2016 ◽

Cited By ~ 5

Author(s):

Amy Peacock ◽

Suzanne Nielsen ◽

Raimondo Bruno ◽

Gabrielle Campbell ◽

Briony Larance ◽

...

Keyword(s):

Health Service ◽

Cancer Pain ◽

Geographic Variation ◽

Service Use ◽

Opioid Therapy ◽

Health Service Use ◽

Access Barriers ◽

Perceived Access

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Identifying appropriate outcomes to help evaluate the impact of the Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain

BMC Anesthesiology ◽

10.1186/s12871-020-0930-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Michael Allen ◽

Beth Sproule ◽

Peter MacDougall ◽

Andrea Furlan ◽

Laura Murphy ◽

...

Keyword(s):

Cancer Pain ◽

Patient Outcomes ◽

Opioid Therapy ◽

Data Sources ◽

Prescription Opioid ◽

Advisory Group ◽

Opioid Overdose ◽

Canadian Guideline ◽

Effective Use ◽

The Impact

Abstract Background The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes. Methods A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes. Results Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases. Conclusion Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.

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