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Analgesia

Date Last Search Run: Oct 01, 2021
Table last updated: Dec 12, 2017
Data last added: Jul 28, 2015

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)      
3 (weak evidence exists)  


Interventions

Acetaminophen
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Pain relief Patient In-Patient Israel F., Parker G., Charles M., et al. Lack of Benefit From Paracetamol (Acetaminophen) for Palliative Cancer Patients Requiring High-Dose Strong Opioids: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial of Pain and Symp Mngmnt 2010; 39(3):548-54. Medline

Benzodiazepines
Level Direction Primary Outcome Patient/Process Setting Reference

Corticosteroids
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Analgesia Patient In-Patient Paulsen O., Aass N., Kaasa S., et al. Do Corticosteroids Provide Analgesic Effects in Cancer Patients? A Systematic Literature Review. J of Pain and Symp Mngmnt 2013; 46:96-105. Medline

Fentanyl
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain intensity difference at 30 minutes Patient In-Patient Kosugi T., Takigawa C., Shinozaki K., Kunikane H., Goto F., Tanda S., Shima Y., Yomiya K., Matoba M., Adachi I., Yoshimoto T., Eguchi K. A Randomized, Double-Blind, Placebo-Controlled Study of Fentanyl Buccal Tablets for Breakthrough Pain: Efficacy and Safety in Japanese Cancer Patients. J of Pain and Symp Mngmnt 2014; 47:6. Medline
I Supportive (Green) Pain relief Patient ED-MD Kress H., Ororiska A., Kaczmarek Z. Efficacy and Tolerability of Intranasal Fentanyl Spray 50 to 200 ug for Breakthrough Pain in Patients With Cancer: A Phase III, Multinational, Randomized, Double-Blind, Placebo-Controlled, Crossover Trial With a la-Month, Open-Label Extension Treatment Period. Clin Thera 2009; 31(6):1177-91. Medline
I Supportive (Green) Breakthrough pain relief Patient In-Patient Rauck R., Tark M., Reyes E. Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Current Med Research & Opinion 2009; 25(12):2877–85. Medline
III Supportive (Green) Pain control Patient ED-MD Guilherme L., Soares L., Martins M., Uchoa R. Intravenous Fentanyl for Cancer Pain: A “Fast Titration” Protocol for the Emergency Room. J of Pain and Symp Mngmnt 2003; 2:3. Medline
III Supportive (Green) Pain relief Patient In-Patient Klepstad P., Kaasa S., Borchgrevink P. Starting Step III opioids for moderate to severe pain in cancer patients: Dose titration: A systematic review. Palliative Medicine 2010; 25(5):424-30. Medline
III Supportive (Green) Safety and efficacy Patient In-Patient Takigawa C., Goto F., Tanda S., Shima Y., Yomiya K., Matoba M., Adachi I., Yoshimoto T., Eguchi K. Breakthrough pain management using fentanyl buccal tablet (FBT) in combination with around-the-clock (ATC) opioids based on the efficacy and safety of FBT, and its relationship with ATC opioids: results from an open-label, multi-center study in Japanese cancer patients with detailed evaluation. Japanese J of Clin Onc 2015; 45:1: 67–74. Medline
III Supportive (Green) Tolerability Patient In-Patient Taylor D., Radbruch L., Revnic J., Torres L., Ellershaw J., Perelman M. A Report on the Long-Term Use of Fentanyl Pectin Nasal Spray in Patients With RecurrentBreakthrough Pain. J Pain Symptom Manage 2014; 47(6):1001-7. Medline

Hydromorphone
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Pain relief Patient In-Patient Watanabe S., Pereira J., Tarumi Y. A Randomized Double-Blind Crossover Comparison of Continuous and Intermittent Subcutaneous Administration of Opioid for Cancer Pain. J of Pall Med 2008; 11(4):570-574. Medline

Inhaled analgesic
Level Direction Primary Outcome Patient/Process Setting Reference

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference

Ketorolac (Toradol)
Level Direction Primary Outcome Patient/Process Setting Reference

Morphine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain intensity Patient In-Patient Dale O., Piribauer M., Kaasa S., et al. A Double-Blind, Randomized, Crossover Comparison Between Single-Dose and Double-Dose Immediate-Release Oral Morphine at Bedtime in Cancer Patients. J of Pain and Symp Mngmnt 2009; 37(1):68-76. Medline
I Neutral (Yellow) Pain control Patient In-Patient Caraceni A., Pigni A., Brunelli C. Is oral morphine still the first choice opioid for moderate to severe cancer pain? A systematic review within the European Palliative Care Research Collaborative guidelines project. Palliative Medicine 2010; 25(5):402–9. Medline
III Supportive (Green) Efficacy Patient In-Patient Hagen N., Elwood T., Ernst S. Cancer Pain Emergencies: A Protocol for Management. J of Pain and Symp Mngmnt 1997; 14:1. Medline
III Supportive (Green) Pain relief Patient In-Patient Klepstad P., Kaasa S., Borchgrevink P. Starting Step III opioids for moderate to severe pain in cancer patients: Dose titration: A systematic review. Palliative Medicine 2010; 25(5):424-30. Medline
III Supportive (Green) Pain relief Patient ED-MD Kumar S., Rajagopal MR., Naseema AM. Intravenous morphine for emergency treatment of cancer pain. Pall Med 2000; 14:183–8. Medline
III Supportive (Green) Pain relief Patient In-Patient Mercadante S.., Intravaia G., Villari P., Ferrera P., Riina S., Mangione S. Intravenous Morphine for Breakthrough (Episodic-) Pain in an Acute Palliative Care Unit: A Confirmatory Study. Journal of Pain and Symptom Management 2008; 35(3):307-13. Medline

NSAIDs
Level Direction Primary Outcome Patient/Process Setting Reference

Oxycodone
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Analgesia Patient ED-MD King SJ., Reid C., Forbes K. A systematic review of oxycodone in the management of cancer pain. Palliative Medicine 2011; 25(5):454–70. Medline

Topical Narcotic
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Analgesia Patient In-Patient LeBon B., Zeppetella G., Higginson I., Effectiveness of Topical Administration of Opioids in Palliative Care: A Systematic Review. J of Pain and Symp Mngmnt 2009; 37:5: 913-917. Medline


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