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Shen Zhao, Chunwei Xu, Rongbo Lin
(Department of Gastrointestinal Medical Oncology, Fujian Cancer Hospital, Fuzhou, Fujian, China (mainland))
Med Sci Monit 2020; 26:e920598
In 2014, a Chinese expert consensus was proposed regarding a titration protocol with controlled-release (CR) oxycodone as a background dose for relieving the moderate to severe cancer pain. This work aimed to summarize its efficacy and safety in our hospital.
MATERIAL AND METHODS: The Good Pain Management (GPM) protocol comprises a CR morphine or oxycodone given every 12-hours as a background dose and an immediate-release (IR) opioid as a rescue dose. Cancer patients with moderate to severe cancer pain were treated with this protocol, and the successful titration (numerical rating scale [NRS] ≤3 within 3 days) rate was analyzed. SPSS was used for statistical analysis. Differences of variables between opioid intolerant patients and opioid tolerant patients were analyzed using the Mann-Whitney U test. The chi square test was used for comparison of frequencies in different groups. A P-value <0.05 was set as the significance level.
RESULTS: Among 257 enrolled patients, there were 179 opioid intolerant patients and 78 opioid tolerant patients. The successful titration rates were 91.1%, 94.4%, and 83.3% in the total population, in the opioid intolerant patients, and in the opioid tolerant patients, respectively. The successful titration rates and NRS were superior in the opioid intolerant patients compared to the opioid tolerant patients. The most common opioid adverse effects were constipation, somnolence, nausea, mouth dry, and vomiting; and no significant differences in side effects were found between groups.
CONCLUSIONS: Our study supports that the GPM titration protocol is effective for patients with moderate-severe cancer pain, and it is more effective for opioid intolerant patients.