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Single dose oxycodone and oxycodone plus paracetamol (also known as acetaminophen) for analgesia in adults with acute postoperative pain

This review update assessed evidence from 2641 participants in 20 randomised, double blind, placebo‐controlled clinical trials of oxycodone, with or without paracetamol, in adults with moderate to severe acute postoperative pain. Oral oxycodone 10 mg plus paracetamol 650 mg provided effective analgesia. About half of those treated experienced at least half pain relief over 4 to 6 hours, and the effects lasting up to 10 hours. Higher doses gave more effect. Associated adverse events (predominantly nausea, vomiting, dizziness and somnolence) were more frequent with oxycodone or oxycodone plus paracetamol than with placebo, but studies of this type are of limited use for studying adverse effects. Limited information about oxycodone on its own suggests that it provided analgesia at doses greater than 5 mg, and that addition of paracetamol made it more effective.

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

Version: 2016

Tamper-Resistant Oxycodone: A Review of the Clinical Evidence and Cost-effectiveness [Internet]

Requiring tamper-resistant properties for products that contain particular controlled substances in order to be sold can be part of efforts to address prescription drug abuse. The purpose of this review is to evaluate the effectiveness of tamper-resistant formulations in curbing abuse and misuse of oxycodone.

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

Version: June 25, 2015
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Oxycodone for neuropathic pain in adults

There is no good evidence that oxycodone works in pain from diabetic neuropathy or postherpetic neuralgia. No studies have reported its use in other types of neuropathic pain.

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

Version: 2016

Oxycodone for pain in fibromyalgia in adults

There is no good evidence to support or refute the suggestion that oxycodone, alone or in combination with naloxone, reduces pain in fibromyalgia.

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

Version: 2016

Oxycodone for cancer‐related pain

Many patients with cancer experience moderate to severe pain that requires treatment with strong painkillers that are classified as opioids. Oxycodone and morphine are examples of such strong painkillers that are used for the relief of cancer pain. Strong painkillers are, however, not effective for pain in all patients nor are they well‐tolerated by all patients. The aim of this review is to assess whether oxycodone is associated with better pain relief and tolerability than other strong painkillers for patients with cancer pain. We found 17 relevant studies that compared different types of oxycodone to each other or to other strong painkillers. Generally, the studies showed that oxycodone is an equally effective strong painkiller whether taken every 6 or every 12 hours. All the strong painkillers examined in the studies are also associated with a number of unwanted effects, such as vomiting, constipation and drowsiness. Overall, we found that the current evidence base is comprised of studies that contain small numbers of patients of which there is a significant (20%) dropout rate. However, given the absence of important differences within this analysis, it seems unlikely that larger head to head studies of oxycodone versus morphine are justified.

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

Version: 2015

Single dose oral ibuprofen plus oxycodone for acute postoperative pain

Acute pain is often felt soon after injury, and most people who have surgery will have pain of moderate or severe intensity without treatment for their pain. In most, though not all, circumstances, the pain can be treated with oral analgesics. Many oral analgesics are available, and this review is one of a series examining how effective each one is, at particular doses.

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

Version: 2015

Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain

Care pathways are packages of care designed to ensure that patients have appropriate and effective care in particular situations. Such pathways are commonly used, and often produce good results, but they can also be used as a tick box solution that acts as a barrier to good care. Care pathways have been used to ensure appropriate care for people who are dying in hospice settings.

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

Version: 2015

Controlled release formulation of oxycodone in patients with moderate to severe chronic osteoarthritis: a critical review of the literature

Osteoarthritis (OA) is a physically and emotionally debilitating disease that predominantly affects the aging adult population. Current pharmacologic treatment options primarily consist of nonsteroidal anti-inflammatory drugs and/or acetaminophen, but associated side effects, analgesic limitations, especially in the elderly, and the need for around-the-clock analgesia have led physicians to search for alternative analgesics. Opioids have shown effectiveness at mitigating both chronic cancer and noncancer pain, and their ability to be placed into controlled release (CR) formulations suggests that they may prove efficacious for OA patients. One formulation, oxycodone CR, has shown effectiveness in cancer pain patients and in some trials of noncancer low back pain. In this review, the objective was to synthesize the reported findings by researchers in this field and present an up-to-date look at the efficacy, safety, and tolerability of oxycodone CR in OA patients. Public literature databases were searched using specific keywords (eg, oxycodone CR) for studies assessing the efficacy and safety profile of oxycodone CR and its use in patients with OA. A total of eleven articles that matched the criteria were identified, which included three placebo-controlled trials, six comparative trials, one pharmacokinetic study in the elderly, and one long-term safety trial. Analysis of the studies revealed that oxycodone CR is reasonably efficacious, safe, and tolerable when used to manage moderate to severe chronic OA pain, with similar side effects to that of other opioids.

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

Version: 2012

[Undesired side effects of tapentadol in comparison to oxycodone: a meta-analysis of randomized controlled comparative studies]

OBJECTIVE: Tapentadol is a new centrally acting analgesic with a dual mode of action as an agonist of the µ-opioid receptor and as a norepinephrine reuptake inhibitor. The aim of the present study was to evaluate the results from randomized controlled trials investigating the relative amount of adverse effects using tapentadol or oxycodone for the treatment of pain.

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

Version: 2012

Efficacy and tolerability of oxycodone in moderate-severe cancer-related pain: a meta-analysis of randomized controlled trials

The authors concluded that oxycodone was superior to other strong opioids including morphine sulphate, codeine and tramadol, supporting its use as an opioid for cancer-related pain in China. This was a well-conducted review and the results are likely reliable.

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

Version: 2012

Comparison of the postoperative analgesic efficacy of intravenous patient-controlled analgesia with tramadol to intravenous patient-controlled analgesia with opioids

BACKGROUND: Intravenous patient-controlled analgesia (IV PCA) with tramadol is an accepted method to deliver postoperative analgesia outside North America; however, the analgesic efficacy of this analgesic agent when compared with IVPCA with opioids is uncertain. As such, the authors undertook a systematic review to compare the analgesic efficacy of IVPCA tramadol with that of IVPCA with opioids.

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

Version: 2010

Hydromorphone for the treatment of cancer pain

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: 2016

Opiods for restless legs syndrome

Restless legs syndrome (RLS) is a very common neurological disorder in which patients complain of an intense need to move their legs, and unpleasant sensations felt deep in their legs, all occurring while at rest, mostly at bedtime. The number of patients complaining of RLS varies according to race, gender, age, country, and health status. About 5% to 10% of people are affected; , and, among these, 2% to 5% need continual pharmacological treatment (medication). When RLS does not respond to medications generally used for Parkinsons Disease and epilepsy, their doctors often prescribe opioids.

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

Version: 2016

Care of Dying Adults in the Last Days of Life

This guideline applies to dying people aged 18 or older. It is acknowledged that a parallel guideline is being developed by NICE to cover the end of life care for infants, children and young people.

NICE Guideline - National Clinical Guideline Centre.

Version: December 16, 2015
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Long-acting Opioids for Chronic Non-cancer Pain: A Review of the Clinical Efficacy and Safety [Internet]

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
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Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings [Internet]

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

NICE Clinical Guidelines - Centre for Clinical Practice at NICE (UK).

Version: November 2013
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Treatment for Restless Legs Syndrome [Internet]

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a distressing, irresistible urge to move them. RLS severity and burden vary widely, and the condition may require long-term treatment.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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Treatments for Fibromyalgia in Adult Subgroups [Internet]

We conducted a systematic literature review of clinical trials to assess the comparative effectiveness of treatments for fibromyalgia in subgroups of highly affected or clinically complex adults. We focused on patient subgroups rather than overall treatment effects to complement a large systematic review being conducted on fibromyalgia treatments at McMaster University.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2015
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The Management of Hip Fracture in Adults [Internet]

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
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