Palliative medicine
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Palliative medicine · Jul 2011
ReviewEffectiveness of antiepileptic or antidepressant drugs when added to opioids for cancer pain: systematic review.
Neuropathic pain mechanisms are present in up to 40% of patients with cancer pain. In these situations, additional or adjuvant analgesic drugs (such as antidepressants or antiepileptics) are often required to optimize pain control alongside standard opioid therapy. This systematic review aimed to determine the effectiveness of antidepressants and antiepileptics when added to opioids, compared to opioids alone, for the management of pain caused directly by cancer. ⋯ However, a reduction in pain intensity of greater than 1 point on a 0-10 numerical rating scale is unlikely, but an increase in adverse events is likely. For all adjuvants, the effect size was much less than that seen in patients with non-cancer neuropathic pain. Dosing strategies that can be examined in future clinical trials are suggested.
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Palliative medicine · Jul 2011
ReviewA systematic review of combination step III opioid therapy in cancer pain: an EPCRC opioid guideline project.
The use of combinations of opioids is a common clinical practice; however, this is not advocated by the World Health Organization (WHO) analgesic ladder. As opioid combination therapy becomes used increasingly, a review of the evidence on this practice was conducted. ⋯ Only a weak recommendation can be used to support combination opioid therapy. This recommendation is also based on the caveat that the desirable effects of combination opioid therapy is outweighed by any disadvantages that this would confer. Prospective randomized trials are needed to clarify the benefits and safety of combination opioid therapy.
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Palliative medicine · Jul 2011
ReviewTransdermal opioids as front line treatment of moderate to severe cancer pain: a systemic review.
To assess the role of transdermal opioids as a front-line approach to moderate to severe cancer pain. ⋯ The use of slow release oral morphine probably remains the preferred approach for these patients, with the use of transdermal opioids to be reserved for selected patients.