JANUARY 25, 2024
A recently published literature review indicates that there is a lack of data proving the efficacy of opioids versus placebo for relieving persistent cancer pain.
Constant cancer pain is defined as pain that is continuous and relatively constant when a patient is at rest.
“These findings challenge the widely held view that opioids are the most powerful pain relievers for moderate to severe pain,” study researcher Christina Abdel Shaheed, PhD, a National Health and Medical Research
A recently published literature review indicates that there is a lack of data proving the efficacy of opioids versus placebo for relieving persistent cancer pain.
Constant cancer pain is defined as pain that is continuous and relatively constant when a patient is at rest.
“These findings challenge the widely held view that opioids are the most powerful pain relievers for moderate to severe pain,” study researcher Christina Abdel Shaheed, PhD, a National Health and Medical Research Council principal research fellow at the Sydney School of Public Health, in Australia, told Pain Medicine News.
Researchers drew attention to scant evidence confirming that many opioids were more effective than placebo for relieving chronic malignant tumor-related pain (CA Cancer J Clin 2023 Dec 18. doi:10.3322/caac.21823). In fact, the only opiate that had moderate-certainty, placebo-controlled data confirming it was beneficial for this type of pain was prolonged-release tapentadol (maintenance dose, 100-250 mg twice daily for four weeks).
There were placebo-controlled data supporting the use of codeine (30-120 mg) to treat mild to severe chronic or advanced cancer pain with malignancy, but the data were based on low-certainty evidence.
Placebo-controlled data supporting the use of morphine, buprenorphine, tramadol and fentanyl were mostly inconclusive for moderate to severe chronic cancer pain. The researchers were unable to identify any placebo-controlled trials evaluating the efficacy of oxycodone, methadone or hydromorphone for cancer pain relief.
Shaheed noted that as a result of the gaps in the literature that she and her team found, larger, more rigorous and well-designed placebo-controlled trials are needed to determine the efficacy of not only commonly used opioid medicines for cancer pain, but nondrug treatments as well.
“We hope that these findings can help patients and doctors decide on the most appropriate treatment for cancer pain, acknowledging there is no 'one size fits all' approach,” Shaheed said. “There are alternative options for people who are unable to tolerate opioid medicines, choose to not take them or who would like to reduce the amount of opioids they are taking for cancer pain.”
She concluded by noting that for background cancer pain, nonsteroidal anti-inflammatory drugs—aspirin, diclofenac, ketorolac or piroxicam—and imipramine, an antidepressant, may be just as effective as some opioids.
—Myles Starr
Shaheed reported no relevant financial disclosures.
