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Over 75% of people with cancer experience pain. Around 30% to 50% of these people have moderate to severe pain, which can have a negative impact on daily life. Cancer pain is a distressing symptom that tends to worsen as the disease progresses. Hydromorphone may help relieve these symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 11, 2016

There is no good evidence to support or refute the suggestion that hydromorphone works in any neuropathic pain condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

The aim of this systematic review is to evaluate the scientific evidence for the efficacy and side effects of hydromorphone in the management of moderate to severe cancer pain. Randomized and non-randomized clinical trials, reporting data on efficacy and/or side effects of hydromorphone, were identified. Thirteen eligible studies, involving 1208 patients, were selected. Seven studies compared hydromorphone with other opioids (five with morphine, one with oxycodone and one with fentanyl and buprenorphine) and five of them were randomized controlled trials (RCTs). Most of the studies were conducted on patients already receiving opioid treatment, often at stabilized doses, and most had methodological limitations. The RCTs comparing hydromorphone with morphine and oxycodone showed similar analgesic results, while the comparison of side effects showed minor differences, not consistent across studies. Due to clinical and methodological heterogeneity of the studies, a meta-analysis was not performed. In conclusion there is evidence to support the efficacy and tolerability of hydromorphone for moderate to severe cancer pain as an alternative to morphine and oxycodone, while there is no evidence to demonstrate its superiority or inferiority in comparison with morphine as the first choice opioid for the same indication.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The authors concluded that hydromorphone may have been a slightly more effective pain-killer than morphine, but further studies were needed to confirm this. In view of the limited number and size of the trials, heterogeneity and limited size of the effects, the conclusions may not be sufficiently cautious and it is unclear whether they are reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

In about 19 of 20 people with moderate to severe pain from cancer, morphine‐like drugs (opioids) can probably reduce pain to mild or no pain within 14 days if they can tolerate the side effects. Most people will have side effects, and about 1 in 10 to 2 in 10 will need to change their treatment because of side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 6, 2017

An evaluation of the evidence behind the use of sufentanil in palliative pain relief is warranted given the proposed and observed off-label use in palliative care, and the mention of sufentanil within palliative care guidelines. Further, the relatively high cost of sufentanil necessitates an evaluation of resource implications. This report will review the evidence on clinical effectiveness and cost-effectiveness, as well as evidence-based guidelines regarding sufentanil for pain relief specifically in the context of palliative care.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: November 18, 2015

Opioid analgesics are used widely in the treatment of chronic pain. The majority of evidence, however, is from studies on short term use, and opioids are associated with individual adverse events of sedation, cognitive slowing, respiratory depression, overdose, and substance dependence. Upward trends of prescription of opioids have been associated with increased reports of opioid-related deaths, addiction, and drug diversion. It, therefore, is important that opioid prescription be tailored appropriately to need.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 27, 2015

The objective of this review was to perform a systematic review of the beneficial and harmful effects of Fentora for the management of breakthrough pain in cancer patients aged 18 years and older who are already receiving and who are tolerant to continuous opioid therapy for their persistent baseline cancer pain.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: March 2017

Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures, which is associated with poor outcomes for patients. Inadvertent perioperative hypothermia should be distinguished from the deliberate induction of hypothermia for medical reasons, which is not covered by this guideline.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: April 2008

Although hip fracture is predominantly a phenomenon of later life, it may occur at any age in people with osteoporosis or osteopenia, and this guidance is applicable to adults across the age spectrum. Skills in its management have, however been accrued, researched and reported especially by collaborative teams specialising in the care of older people (using the general designation ‘orthogeriatrics’). These skills are applicable in hip fracture irrespective of age, and the guidance includes recommendations that cover the needs of younger patients by drawing on such skills in an organised manner.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2011

Poor pain management in surgical settings is known to be associated with slower recovery, greater morbidity, longer lengths of stay, lower patient satisfaction, and higher costs of care, suggesting that optimal pain care in these settings is of utmost importance in promoting acute illness management, recovery, and adaptation. VA/DoD Clinical Practice Guidelines have been developed for the management of acute post-operative pain, although the basis for many of the recommendations was by expert consensus rather than empirical evidence.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: April 2008

Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO2) in patients receiving general anesthesia. ETCO2 monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption.

CADTH Health Technology Assessment - Canadian Agency for Drugs and Technologies in Health.

Version: March 2016

Opioids (such as morphine and codeine) are strong painkillers best known as treatments for post‐surgical and cancer pain. They are also used for long‐term painful conditions other than cancer and sometimes for symptoms other than pain. They have a number of important adverse effects and their use involves a balance of risks and benefits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 14, 2015

There is no evidence from randomised controlled trials to support or contradict the suggestion that opioids in any dose will reduce cancer‐related pain in children or adolescents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2017

There is no evidence from randomised controlled trials to support or refute the suggestion that opioids in any dose will provide pain relief for chronic non‐cancer pain in children or adolescents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 26, 2017

This summary of a Cochrane review of 22 studies with 8275 participants (search update: 15 August 2012) presents what we know from research about the effect of opioids on osteoarthritis (OA). We searched scientific databases for clinical trials looking at pain, function, safety, and addiction of oral or transdermal opioids compared with placebo or no intervention in people with knee or hip osteoarthritis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 17, 2014

Background The majority of cancer patients with advanced disease have pain. Pain severely impairs health-related quality of life and is the most feared symptom in cancer patients. The quality of palliative treatment of cancer-related pain depends both on knowledge and competence of the health care workers involved, as well as on organisational aspects including a well-developed health services and well-functioning collaboration among health personnel at the different treatment levels. International research as well as national reports emphasize the potential for improving pain therapy for cancer patients in the palliative phase by means of improving all three factors: knowledge, competence and health services organisation.

Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH).

Version: December 2005

This summary of a Cochrane review presents what we know from research about the effect of pain relieving drugs for people with inflammatory arthritis plus stomach or gut disease, or liver disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 18, 2012

Chronic pain is common and use of long-term opioid therapy for chronic pain has increased dramatically. This report reviews the current evidence on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term (≥1 year) outcomes.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2014

There is good‐quality evidence showing that side effects can occur in people with chronic non‐cancer pain who use opioid medicines for longer than two weeks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

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