Shifting Views on Cancer Pain Management: A Systematic Review and Network Meta-Analysis.

Imkamp, Maike S V; Theunissen, Maurice; Viechtbauer, Wolfgang; van Kuijk, Sander M J; van den Beuken-van Everdingen, Marieke H J

Imkamp, Maike S V; Theunissen, Maurice; Viechtbauer, Wolfgang; van Kuijk, Sander M J; van den Beuken-van Everdingen, Marieke H J.

Afiliação

Imkamp MSV; Center of Expertise for Palliative Care; (M.S.V.I., M.T., M.H.J.V.D.B.); Maastricht University Medical Center+ (MUMC+); Maastricht; Netherlands; Department of Clinical Epidemiology and Medical Technology; (M.S.V.I., S.M.J.V.K.); Maastricht University Medical Center+ (MUMC+); Maastricht; Netherlands.
Theunissen M; Center of Expertise for Palliative Care; (M.S.V.I., M.T., M.H.J.V.D.B.); Maastricht University Medical Center+ (MUMC+); Maastricht; Netherlands.
Viechtbauer W; Department of Psychiatry and Neuropsychology; (W.V.); (Faculty of Health; Medicine, and Life Sciences) Maastricht University; Maastricht; Netherlands.
van Kuijk SMJ; Department of Clinical Epidemiology and Medical Technology; (M.S.V.I., S.M.J.V.K.); Maastricht University Medical Center+ (MUMC+); Maastricht; Netherlands.
van den Beuken-van Everdingen MHJ; Center of Expertise for Palliative Care; (M.S.V.I., M.T., M.H.J.V.D.B.); Maastricht University Medical Center+ (MUMC+); Maastricht; Netherlands. Electronic address: m.vanden.beuken@mumc.nl.

J Pain Symptom Manage ; 2024 Jun 04.

Article em En | MEDLINE | ID: mdl-38838946

ABSTRACT

ABSTRACT

CONTEXT Strong opioids are the cornerstone in the treatment of cancer-related pain.

OBJECTIVES:

This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain.

METHODS:

PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks.

RESULTS:

Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP.