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National Collaborating Centre for Cancer (UK). Opioids in Palliative Care: Safe and Effective Prescribing of Strong Opioids for Pain in Palliative Care of Adults. Cardiff (UK): National Collaborating Centre for Cancer (UK); 2012 May. (NICE Clinical Guidelines, No. 140.)

Appendix EEvidence tables

3.1. Communication

Review question 1. What information do patients with advanced and progressive disease who require strong opioids, or their carers, need to: 1) Consent to opioid treatment and 2) monitor the effectiveness and side effects of the opioid?

Evidence table 1. (PDF, 110K)

3.3. Starting strong opioids – titrating the dose with immediate-release, sustained-release or transdermal patches

Review question 2. What is the most effective first-line opioid treatment in patients with advanced and progressive disease who require strong opioids?

2a: Are immediate-release opioids (morphine/oxycodone) more effective than sustained-release opioids (morphine/oxycodone) or opioid patches (fentanyl/buprenorphine) as first-line treatment for pain in patients with advanced and progressive disease who require strong opioids?

Evidence table 2. (PDF, 840K)

3.4. First-line maintenance treatment

2b: Is sustained-release morphine more effective than sustained-release oxycodone or transdermal patches (fentanyl/buprenorphine) as first-line maintenance treatment for pain in patients with advanced and progressive disease who require strong opioids?

Evidence table 3. (PDF, 253K)

3.5. First-line treatment if oral opioids are not suitable – transdermal patches

2c: Are fentanyl patches more effective than buprenorphine patches as first-line treatment for pain in patients with advanced and progressive disease who require strong opioids and for whom oral treatment is not suitable?

Evidence tables 4. (PDF, 168K)

3.6. First-line treatment if oral opioids are not suitable – subcutaneous delivery

2d: Is subcutaneous morphine more effective than subcutaneous diamorphine or subcutaneous oxycodone as first-line treatment for pain in patients with advanced and progressive disease who require strong opioids and for whom oral opioids are not suitable?

No evidence was identified for this review question

3.7. First-line treatment if oral opioids are not suitable – transdermal patch versus subcutaneous delivery

2e: Is subcutaneous opioid treatment more effective than transdermal patch treatment as first-line treatment for pain in patients with advanced and progressive disease who require strong opioids and for whom oral opioids are not suitable?

No evidence was identified for this review question

3.8. First-line treatment for breakthrough pain in patients who can take oral opioids

2f: What is the most effective opioid treatment for breakthrough pain in patients with advanced and progressive disease who receive first-line treatment with strong opioids (for background pain)?

Evidence table 5. (PDF, 242K)

3.9. Management of constipation

Review question 3. What is the most effective management of side effects of strong opioids?

3a: Is laxative treatment more effective with or without opioid switching in reducing constipation in patients with advanced and progressive disease who are taking strong opioids and experience constipation as a side effect?

No evidence was identified for this review question

3.10. Management of nausea

3b: Is anti-emetic treatment more effective with or without opioid switching in reducing nausea in patients with advanced and progressive disease who are taking strong opioids and experience nausea as a side effect?

No evidence was identified for this review question

3.11. Management of drowsiness

3c: Is opioid dose reduction or switching opioid more effective in reducing drowsiness in patients with advanced and progressive disease on strong opioids who experience drowsiness as a side effect?

No evidence was identified for this review question

Copyright 2012, © National Collaborating Centre for Cancer.