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J Opioid Manag. 2014 Jan-Feb;10(1):29-38. doi: 10.5055/jom.2014.0189.

Opioid titration with sustained-release oxycodone and immediate-release morphine for moderate/severe cancer pain: a pilot assessment of the CoDem protocol.

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  • 1Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy.
  • 2Post Graduate School of Anesthesia and Intensive Care, University of Bologna, Bologna, Italy.
  • 3Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy.
  • 4Department of Medical and Surgery Sciences, University of Bologna, Bologna, Italy; Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.

Abstract

OBJECTIVES:

Opioid titration is the first challenging stage for rapid control of moderate/severe cancer pain. Evidence shows that sustained-release formulations may be used for opioid titration. We set a pilot assessment of the efficacy and tolerability of our in-house protocol (continuous and on demand opioids [CoDem]) of the association of sustained-release oxycodone and immediate-release morphine as rescue dose for opioid titration/rotation in opioid-naïve (NAOP, n = 13), tolerant to weak (WOP, n = 20), or strong opioids (STOP, n = 44) in-patients with moderate/severe cancer pain.

METHODS:

Observational and retrospective analysis of cancer in-patients treated for ≥7 days with the CoDem protocol.

OUTCOME MEASURES:

Pain intensity (patients self-reported pain with numerical rating scale [NRS] under static [NRSs] and dynamic [NRSd] conditions), amount of drug consumption, opioid adverse effects, and patient satisfaction.

EFFICACY ENDPOINTS:

In more than 50 percent of the patients and in <72 hours, steady NRSs and NRSd score reduction of at least two points, NRSs ≤ 3 and NRSd ≤4; and mean daily morphine consumption < mean of one rescue dose and t1:t6 ratio of mean oxycodone daily dose < 1:2.

RESULTS:

Endpoints were reached within 24 hours both within the sample and subgroups. Only NAOP patients reached NRSd ≤ 4 endpoint within 48 hours. Against moderate and transient adverse effects, most patients (84.4 percent) found pain treatment to be good or excellent.

CONCLUSIONS:

The CoDem protocol was shown to be effective and reasonably tolerated for titration for moderate/severe cancer pain relief in both opioid-naïve or opioid-tolerant cancer in-patients. This pilot assessment warrants prospective and comparative studies with larger samples for more generalized results.

PMID:
24604567
[PubMed - indexed for MEDLINE]
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