Equianalgesic dose guidelines for long-term opioid use: Theoretical and practical considerations

Quality assessment of the methods used in published opioid conversion reviews

The study objective was to assess methodological quality of opioid conversion systematic reviews. The electronic databases PubMed, EMBASE, and Scopus were used to identify the systematic reviews from the earliest available date until April 2012. Studies were not restricted based on type of opioid, country, or languages. Methodological quality was evaluated using the "Assessment of Multiple Systematic Reviews (AMSTAR)." A total of 2772 articles were found from which five met inclusions criteria. No review mentioned about the duplicate study selection and data extraction. Two reviews included a list of studies that were excluded studies. One study did not provided information on the characteristics of primary studies that were included. Of the three reviews that evaluated the quality of primary studies, two used the quality of included studies in formulating conclusions. Only two reviews provided information about conflicts of interest. Of the five included systematic reviews, three reached a moderate score; two had poor quality. Specific recommendations to improve methodological quality would include performing the data selection and extraction in duplicate, listing or showing the flowchart of studies that were included and excluded along with the reasons, including the main studies data illustrating tables, and including an assessment of the quality of the primary included studies.

A preliminary investigation into the practicality of use and duration of action of slow-release preparations of morphine and hydromorphone in laboratory rats

Significant advances have been made in our ability to assess pain and administer appropriate pain relief in laboratory animals. However, providing long-lasting analgesia using a route that does not involve animal restraint remains difficult. The objective of this study was to investigate whether oral administration of slow-release morphine or hydromorphone results in increased thermal nociception in laboratory rats. The results showed that 64 mg/kg morphine and 16 mg/kg hydromorphone induced comparable increases in foot withdrawal latencies for up to three hours postadministration; however, slow-release morphine increased response latencies for up to 11 hours. Whether these dose rates provide clinically effective pain relief has yet to be determined; however, these data suggest that using slow-release preparations could be an effective and highly practical method of elevating pain thresholds for a relatively prolonged period.

Elderly patients with painful bone metastases should be offered palliative radiotherapy

PURPOSE

To investigate the efficacy of palliative radiotherapy (RT) in relieving metastatic bone pain in elderly patients.

METHODS AND MATERIALS

The response to RT for palliation of metastatic bone pain was evaluated from a prospective database of 558 patients between 1999 and 2008. The pain scores and analgesic intake were used to calculate the response according to the International Bone Metastases Consensus Working Party palliative RT endpoints. Subgroup analyses for age and other demographic information were performed.

RESULTS

No significant difference was found in the response rate in patients aged >or=65, >or=70, and >or=75 years compared with younger patients at 1, 2, or 3 months after RT. The response was found to be significantly related to the performance status.

CONCLUSION

Age alone did not affect the response to palliative RT for bone metastases. Elderly patients should be referred for palliative RT for their painful bone metastases, regardless of age, because they receive equal benefit from the treatment.