The Best Opioid Option for
Cancer Related Pain
Justin Marthaler RN
University of Wisconsin – Green Bay
PICO Question
Does methadone treat patients with
cancer related pain more effectively
compared to other first line opioids...
If the most effective opioid is selected to
treat cancer related pain it could reduce
hospitalizations related uncontrolle...
Who is effected?
-Patients
-Families
-Nurses
-Physicians
-Hospitals
-Drug companies
Studies
Mercadante, S., Porzio, G., Ferrera, P.,
Fulfaro, F., Aielli, F., Verna, L., ... &
Mangione, S. (2008). Sustained-...
Design/ Methods
Multicenter prospective randomized
controlled study.

Objective

Compare the analgesic and adverse
effects...
Sample
N= 108

Advanced cancer patients with pain
requiring strong opioids that have failed
opioids for mild to moderate p...
Measurement
-Spitzer QoL Index – 5 questions using Likert
three point scale.
-Symptoms associated with opioid
therapy, suc...
Measurement
-Pain intensity, measured using the patient’s
self report on a numerical 0–10 scale.
Results
-All of the opioids tested as a first line
therapy were effective and well tolerated.
-Although costs are differen...
Supportive Material
The conclusion is supported by the
American Society of Anesthesiologists who
have created a Clinical P...
Supportive Material
According to the European Association for
Palliative Care (EAPC), “The data show no
important differen...
Acknowledgements
Mercadante, S., Porzio, G., Ferrera, P.,
Fulfaro, F., Aielli, F., Verna, L., ... &
Mangione, S. (2008).
S...
Acknowledgements
Caraceni, A., Hanks, G., Kaasa, S., Bennett,
M. I., Brunelli, C., Cherny, N., ... & Zeppetella,
G. (2012)...
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The best opioid option for cancer related pain

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The best opioid option for cancer related pain

  1. 1. The Best Opioid Option for Cancer Related Pain Justin Marthaler RN University of Wisconsin – Green Bay
  2. 2. PICO Question Does methadone treat patients with cancer related pain more effectively compared to other first line opioids such as morphine and fentanyl over a period of 1 month? Innovation The most effective opioid will be selected to treat cancer related pain.
  3. 3. If the most effective opioid is selected to treat cancer related pain it could reduce hospitalizations related uncontrolled pain, cut hospital costs, and improve patient satisfaction ratings.
  4. 4. Who is effected? -Patients -Families -Nurses -Physicians -Hospitals -Drug companies
  5. 5. Studies Mercadante, S., Porzio, G., Ferrera, P., Fulfaro, F., Aielli, F., Verna, L., ... & Mangione, S. (2008). Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. European Journal of Pain, 12(8), 1040-1046.
  6. 6. Design/ Methods Multicenter prospective randomized controlled study. Objective Compare the analgesic and adverse effects as well as cost of opioids used to treat cancer related pain. Specifically, sustained release morphine, transdermal fentanyl, and oral methadone.
  7. 7. Sample N= 108 Advanced cancer patients with pain requiring strong opioids that have failed opioids for mild to moderate pain. Patients were excluded if they had liver or renal disease, cognitive impairment, life expectancy of less than 3 months, required radiation therapy or chemotherapy.
  8. 8. Measurement -Spitzer QoL Index – 5 questions using Likert three point scale. -Symptoms associated with opioid therapy, such as nausea and vomiting, drowsiness, and confusion, were recorded using a scale from 0 to 3.
  9. 9. Measurement -Pain intensity, measured using the patient’s self report on a numerical 0–10 scale.
  10. 10. Results -All of the opioids tested as a first line therapy were effective and well tolerated. -Although costs are different for each of the opioids there is not a first line opioid that is recommended over another.
  11. 11. Supportive Material The conclusion is supported by the American Society of Anesthesiologists who have created a Clinical Practice Guideline related to the treatment of cancer related pain. http://www.asahq.org/ForMembers/Practice-Management/PracticeParameters/Practice-Guidelines-for-CancerPain-Management.aspx
  12. 12. Supportive Material According to the European Association for Palliative Care (EAPC), “The data show no important differences between morphine, oxycodone, and hydromorphone given by the oral route and permit a weak recommendation that any one of these three drugs can be used as the first choice step III opioid for moderate to severe cancer pain.” (Caraceni, A., Hanks, G., Kaasa, S., Bennett, M. I., Brunelli, C., Cherny, N., ... & Zeppetella, G. (2012)
  13. 13. Acknowledgements Mercadante, S., Porzio, G., Ferrera, P., Fulfaro, F., Aielli, F., Verna, L., ... & Mangione, S. (2008). Sustained‐release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. European Journal of Pain, 12(8), 1040-1046.
  14. 14. Acknowledgements Caraceni, A., Hanks, G., Kaasa, S., Bennett, M. I., Brunelli, C., Cherny, N., ... & Zeppetella, G. (2012). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. The lancet oncology,13(2), e58-e68.

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