New strategies in opioid
therapy for cancer pain

by
Cherny N
Cancer Pain & Palliative Medicine Section,
Department of Medical Oncology,
Shaare Zedek Medical Center,
Jerusalem, Israel.
J Oncol Manag 2000 Jan-Feb; 9(1):8-15


ABSTRACT

BACKGROUND: The last decade has seen a great increase in the range of opioid agents and formulations available for the treatment of chronic pain, raising new clinical questions and options. METHODS: The author conducted an extensive review of the existing medical literature on opioid agents and formulations currently available. RESULTS: Opioids remain the cornerstone of pharmacotherapy for cancer pain. In addition to severity of pain, coexisting disease, response to previous therapy, the drug's pharmacokinetics and available formulations influence the choice of an opioid agent. Short-half-life drugs, such as morphine, hydromorphone, fentanyl, oxycodone, and oxymorphone, are generally favored initially because they are easier to titrate than long-half-life agents. Long-acting controlled-release opioid preparations can lessen the inconvenience of around-the-clock administration of drugs with a short duration of action. In recent years several new formulations have been developed, including controlled-release morphine suppositories and suspensions; controlled-release tablets of oxycodone, hydromorphone, and codeine; and transdermal fentanyl, a patch that allows 3-day dosing and avoids the first-pass effect of the liver. Most patients who receive controlled-release opioids should be provided with a rescue dose of an immediate-release opioid to treat pain that may break through the controlled-release schedule. CONCLUSIONS: Among the important advances in the last decade in the treatment of chronic pain is the realization that the goals of care and the best means of achieving them differ not only among individuals but often for a single patient throughout a long course of care. Physicians must not only be knowledgeable but also flexible in their approach to managing cancer pain. An understanding of the range of opioid agents and the formulations available can allow physicians to maintain the best possible quality of life for their patients with chronic pain.
Pain
NMDA
Fentanyl
Morphine
Fetal pain
Nociceptin
Oxycodone
Endomorphins
Opium timeline
Opioid receptors
Neuropathic pain
NMDA anatagonists
Spinal opioid therapy
Endomorphins 1 and 2
The Pleasures of Opium
Opioids and anaesthesia
Is morphine a smart drug?
Endomorphins and the mouse
Endomorphins and rodent brains
Analgesia and combination analgesics
Endomorphins and the mu-opioid receptor


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