Severe pain management in patient with cancer – an analysis of the literature 2017-2020

Abstract

Objective: The aim of the paper was to review the literature to understand the scientific use of strong opioids for the management of severe background pain and incidents in cancer patients.

Material and method: A systematic literature review was performed: 42 articles were included published in the period 2017-2020.

Results: Morphine (po), Fentanyl (transdermal) and Oxycodone (po) were the first three most commonly administered opioids. In the case of severe background pain, the oral administration of opioids was mainly used, and for incident pain, the oral and transdermal route. The side effects of opioids are respiratory disorders due to apnoea and the risk of infections, which increases by 2% for every 10 mg of oral morphine. In the case of cancer of the abdominal-pelvic organs, the main trigger of pain was food ingestion, and in the case of lung cancer food ingestion, movement and cough. The combinations agonist + antagonist, Oxycodone-Naloxone and Morphine-Naloxone have a good analgesic effect and reduce the risk of side effects and toxicity by adding the antagonist. The effectiveness of Methadone is similar to that of Fentanyl, and Morphine and Oxycodone administered orally have an analgesic effect similar to that of Fentanyl and Buprenorphine administered transdermally. The main reasons for opioid rotation were: inefficient analgesia, side effects and dysphagia. Methadone can be used successfully in oxycodone-refractory pain. Two new modes of opioid conversion were found.

Conclusion. The treatment of severe pain in patients with neoplasms remains a challenge for the medical system. Grade III opioids, especially Morphine, Fentanyl and Oxycodone are the pharmaceutical methods of choice for combating pain in these patients.

Keywords: palliative care, opioids, pain, cancer

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