A groundbreaking review, the largest of its kind, on opioid medications for cancer pain has raised critical questions about their effectiveness and suggests that alternatives like aspirin may be just as good.
This study, published in the CA: A Cancer Journal for Clinicians, conducted by The University of Sydney and The University of Warwick, has led to a significant reassessment of pain management in cancer care.
Traditionally, opioids have been seen as the most potent pain relievers for cancer patients.
They are widely recommended by international guidelines, including those of the World Health Organization, for managing both constant (background) and temporary (breakthrough) cancer pain.
However, this comprehensive review has unearthed surprising gaps in evidence about the actual benefits of these medicines.
Surprisingly, the study found that popular opioid medicines like morphine, oxycodone, and methadone, when compared to a placebo, didn’t show clear superiority in managing cancer pain.
This is particularly striking as morphine is often considered the “gold standard treatment” for cancer pain, especially due to its affordability and accessibility.
Moreover, the review suggests that non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and diclofenac might be as effective as some opioids for managing cancer pain.
This finding challenges the conventional reliance on opioids and opens the door to potentially safer pain management options with fewer side effects.
Professor Martin Underwood from the University of Warwick notes that people with cancer pain might have a better overall experience if the focus shifts away from opioids.
The lack of direct comparison of opioids with placebos in trials, as pointed out by Dr. Christina Abdel Shaheed from the University of Sydney, reflects the ethical and logistical challenges in such studies but highlights the need for them in guiding clinical decisions.
Professor Jane Ballantyne from the University of Washington School of Medicine emphasizes the surprising effectiveness of non-opioids for some cancer pains and the potential issues with opioid dependence and decreasing effectiveness over time.
Dr. Mark Sidhom from Liverpool Hospital, Australia, hopes that these findings will empower doctors and patients to make informed choices between different opioid treatments and consider alternatives, especially for those who cannot tolerate or choose not to take opioids.
Key findings of the study include:
- The review analyzed data from over 150 clinical trials.
- Very few trials directly compared opioid medicines with placebos.
- Moderate certainty evidence suggests that tapentadol, an opioid, is more effective than placebo for background cancer pain.
- “Weaker” opioids like codeine, or NSAIDs such as aspirin and diclofenac, might be as effective as stronger opioids for background cancer pain, and with fewer side effects.
- For breakthrough cancer pain, fentanyl in various forms might be more effective than placebo, though not for regular use, and with more side effects.
- There’s a possibility that morphine and other opioids might interfere with cancer treatment effectiveness or the immune system, necessitating further research.
- More research is needed on non-drug interventions for cancer pain management.
This study marks a significant shift in understanding cancer pain management, advocating for a more nuanced and individualized approach that balances efficacy with safety and patient preference.
If you care about pain, please read studies about how to manage your back pain, and Krill oil could improve muscle health in older people.
For more information about pain, please see recent studies about how to live pain-free with arthritis, and results showing common native American plant may help reduce diarrhea and pain.
The research findings can be found in CA: A Cancer Journal for Clinicians.
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