A short Powerpoint presentation about the use of opioids to treat cancer related pain.

1. The Best Opioid Option for
Cancer Related Pain
Justin Marthaler RN
University of Wisconsin – Green Bay

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. 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. Who is effected?
-Patients
-Families
-Nurses
-Physicians
-Hospitals
-Drug companies

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. 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. 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. 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. Measurement
-Pain intensity, measured using the patient’s
self report on a numerical 0–10 scale.

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. 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. 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. 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. 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.