Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Cancer Pain Management - Opioids

Article information

J Korean Med Assoc. 2010;53(3):250-257
Publication date (electronic) : 2010 March 31
doi : https://doi.org/10.5124/jkma.2010.53.3.250
Soo Seog Park, MD
Department of Anesthesiology and Pain Medicine, The Catholic University College of Medicine, Korea. sspark7@yahoo.co.kr

Abstract

Opioids are the most effective analgesics for cancer pain treatments. But the ineffective treatment of cancer pain is often related to insufficient knowledge of opioids and fear of the addiction along with the side effects. To achieve effective treatment of cancer pain with opioids, we need a careful assessment of pain, proper use of opioids and regular review of the effectiveness of prescribed opioids. Basic principles of opioids therapy in cancer pain are ① Oral opioids (or transdermal) if possible; ② Combination of long-acting opioids for constant pain with short-acting opioids for breakthrough pain; ③ "Opioids rotation"in poor analgesia and significant side effects with the calculations of the morphine equivalent daily dose (MEDD) ④ Initiation of prophylactic treatment for constipation and nausea. In this review, I will describe the essential aspects of opioids therapy, pharmacology, rotation, properties of the individual opioids, and management of common side effects.

Keywords: Cancer pain; Opioids therapy; Opioids rotation

References

1. Mikhail F, Madhuri A, Allen WB. The role of opioids in cancer pain management. Pain Practice 2005. 543–54.
2. World Health organization. Cancer pain relief 1996. 2nd edth ed. Geneva: WHO office of Publication;
3. Indelicato RA, Portenoy RK. Opioid rotation in the management of refractory cancer pain. J Clin Oncol 2002. 20348–352.
4. Bruera E, Kim HN. Cancer Pain. JAMA 2003. 2902476–2479.
5. Gourlay GK. Treatment of cancer pain with transdermal fentanyl. Lancet Oncol 2001. 2165–172.

Article information Continued

Copyright © 2010 Korean Medical Association

Figure 1

Figure 1

Opioids rotation.

Table 1

Classification of cancer pain

Table 1

Table 2

Classification of opioid analgesics

Table 2

Table 3

Characteristics of opioids for moderate to severe pain

Table 3

*IR: immediate release, CR: controlled release

**M3G: Morphine-3-glucuronide, M6G: Morphine-6-glucuronide

***SSRI: Selective serotonin uptake inhibitors

Table 4

Transdermal fentanyl dosing (Fentanyl patch; oral morphine=1 : 150)

Table 4

Table 5

Opioids rotation (ex: From oxycodone to transdermal fentanyl)

Table 5

Table 6

From morphine to transdermal fentanyl

Table 6

Table 7

From transdermal fentanyl to morphine.

Table 7

Table 8

Equianalgesic dose of opioids

Table 8

Example; Morphine (IV/SC)10 mg=Morphine (PO)25 mg *, Oxycodone (PO)15 mg=Morphine (PO)10 mg **