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Drug Class Review: Long-Acting Opioid Analgesics: Final Update 6 Report [Internet]

Drug Class Review: Long-Acting Opioid Analgesics: Final Update 6 Report [Internet]

Drug Class Reviews - Oregon Health & Science University

Version: July 2011

Evidence Tables

OROS hydromorphone QD max dose 64 mg


Through Update 5, a total of 34 randomized trials were included (8 head-to-head trials of long-acting opioids, 19 placebo-controlled or active-control trials of long-acting opioids, and 7 trials of long-acting vs. a short-acting opioid). Results of literature searches for Update 6 are shown in Figure 1. Searches identified 935 citations. Full-text citations of 47 of these were retrieved for further review and 9 studies were included. Excluded studies for Update 6 are listed in Appendix D.


The results of this review are summarized in Table 8, below, and Appendix E summarizes the strength of the evidence for each key question. Although we identified 10 head-to-head trials comparing 2 or more long-acting opioids, the evidence was insufficient to determine if there are differences among the drugs. Eight trials found no significant difference in pain relief or function between long-acting opioids. The 2 trials which found a significant difference (1 trial of transdermal fentanyl vs. oral long-acting morphine and 1 trial of extended-release morphine vs. sustained-release oxycodone) were both open-label, rated poor quality, and were inconsistent with higher-quality trials evaluating the same comparison that found no significant differences.


Chronic pain, typically defined as pain for at least 3 to 6 months, is a common cause of major disability. An estimated 1 in 5 adult Americans, or 30 million people, experience chronic pain. Chronic noncancer pain afflicts a significant subset of patients, causing personal suffering, reduced productivity, and substantial health care costs. Opioids have been endorsed by the American Academy of Pain Medicine, the American Pain Society, and the Canadian Pain Society, among others, as appropriate treatment for refractory chronic noncancer pain in the general population and in older patients, when used judiciously and according to guidelines similar to those followed with cancer patients.

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