Takemura M, Niki K, Okamoto Y, Tamura H, Kawamura T, Kohno M, Matsuda Y, Ikeda K. Differences in the Analgesic Effect of Opioids on Pain in Cancer Patients With Spinal Metastases.
Palliat Med Rep 2023;
4:220-230. [PMID:
37637760 PMCID:
PMC10457616 DOI:
10.1089/pmr.2023.0018]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background
Spinal metastasis pain includes both inflammatory and neuropathic pain, and opioids, which have only a μ-opioid receptor-stimulating effect, are generally less effective in neuropathic pain. However, no previous study has been conducted for the comparisons of the efficacy of opioids in treating spinal metastasis pain.
Objective
To compare the efficacy of tapentadol and methadone with other opioids for back pain caused by a metastatic spinal tumor.
Design
Retrospective cohort study.
Setting/Subjects
A total of 274 patients were enrolled, who started a tapentadol extended-release tablet, methadone tablet, hydromorphone extended-release tablet, oxycodone extended-release tablet, or transdermal fentanyl patch for cancer pain due to spinal metastasis in Japan from January 1, 2013 to October 31, 2021.
Measurements
The primary endpoint, the difference in the numerical rating scale (NRS) scores before and seven days after each opioid administration, was compared among the five groups.
Results
In patients with numbness, a decrease of the NRS score on day seven compared with before starting each opioid was significantly higher in the tapentadol group than those in the hydromorphone, oxycodone, and fentanyl groups and comparable to that in the methadone group. In patients without numbness, no significant differences were observed in decreases of the NRS scores on day seven among the five groups.
Conclusions
Tapentadol and methadone may be more effective than hydromorphone, oxycodone, and fentanyl for cancer pain due to spinal metastasis with numbness.
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