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Rapid Titration With Intravenous Oxycodone for Severe Cancer Pain and Oral Conversion Ratio

      Abstract

      Context

      to assess a dose titration with intravenous oxycodone to achieve rapid pain relief of cancer pain of severe intensity. The second objective was to provide a conversion ratio with the oral route.

      Methods

      Cancer patients admitted for severe pain were prospectively assessed. At admission (T0) previous opioid doses were recorded. Edmonton symptom assessment scale (ESAS) was collected from T0 until the conclusion of the observation. Intravenous boluses of oxycodone were given until the initial signs of significant analgesia were detected. The effective dose was multiplied for six and given as intravenous continuous infusion. When the patient was considered stabilized the intravenous daily dose was converted to oral oxycodone using an initial ratio of 1:2. Subsequently, doses of oral oxycodone were changed according to the clinical situation.

      Results

      Twenty-nine patients were examined. A mean effective bolus dose of oxycodone was 9.5 mg (SD 8.0) allowed to achieve a meaningful pain relief in a mean of 10.4 minutes (SD 3.3). The mean initial and the final infusion doses were 51.0 mg/day (standard deviation 40.9) and 69.7 mg/day ( standard deviation76.6), respectively. A significant change in pain intensity was observed at the different time intervals (P<0.0005). Conversion to oral route occurred after a mean of 2.7 days (standard deviation1.2) of intravenous oxycodone. The final mean conversion ratio was 1:2,12 ( standard deviation0.36).

      Conclusion

      Rapid intravenous oxycodone dose titration resulted in rapid pain relief. The intravenous-oral conversion ratio of 1:2 is reliable. Further studies are necessary to confirm this preliminary observation.

      Key Words

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      REFERENCES

        • Caraceni A
        • Hanks G
        • Kaasa S
        • et al.
        • European Palliative Care Research Collaborative (EPCRC); European Association for Palliative Care (EAPC)
        Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC.
        Lancet Oncol. 2012; 13 (e58-68)
        • Bennett MI
        • Eisenberg E
        • Ahmedzai SH
        • et al.
        Standards for the management of cancer-related pain across Europe – a position paper from the EFIC Task Force on Cancer Pain.
        Eur J Pain. 2019; 23: 660-668
        • Mercadante S.
        Opioid titration in cancer pain: a critical review.
        Eur J Pain. 2007; 11: 823-830
        • Mercadante S.
        Intravenous morphine for management of cancer pain.
        Lancet Oncol. 2010; 11: 484-489
        • Bouassirha D
        • Attal N
        • Alchaar H
        • et al.
        Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
        Pain. 2005; 114: 29-36
        • Hui D
        • Bruera E.
        The Edmonton Symptom Assessment System 25 years later: past, present, and future developments.
        J Pain Symptom Manage. 2017; 53: 630-643
        • Mercadante S
        • Villari P
        • Ferrera P
        • Casuccio A
        • Fulfaro F.
        Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion.
        Cancer. 2002; 95: 203-208
        • Mercadante S
        • Villari P
        • Ferrera P
        • Casuccio A.
        Opioid-induced or pain relief-reduced symptoms in advanced cancer patients?.
        Eur J Pain. 2006; 10: 153-159
        • Fainsinger RL
        • Fairchild A
        • Nekolaichuk C
        • et al.
        Is pain intensity a predictor of the complexity of cancer pain management?.
        J Clin Oncol. 2009; 27: 585-590
        • Mercadante S
        • Gebbia V
        • David F
        • et al.
        Ficorella Does pain intensity predict a poor opioid response in cancer patients?.
        Eur J Cancer. 2011; 47: 713-717
        • Mercadante S
        • Adile C
        • Aielli F
        • et al.
        Personalized pain goals and responses in advanced cancer patients.
        Pain Med. 2020; 21: 215-221
        • Kalso E
        Oxycodone.
        J. Pain Symptom Manage. 2005; 29: S47-S56
        • Leow KP
        • Smith MT
        • Williams B
        • Cramond T
        Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer.
        Clin. Pharmacol. Ther. 1992; 52: 487-495
        • Klepstad P
        • Kaasa S
        • Skauge M
        • Borchgrevink PC.
        Pain intensity and side effects during titration of morphine to cancer patients using a fixed schedule dose escalation.
        Acta Anaesthesiol Scand. 2000; 44 (656-64)
        • Harris JT
        • Suresh Kumar K
        • Rajagopal MR
        Intravenous morphine for rapid control of severe cancer pain.
        Palliat Med. 2003; 17: 248-256
        • Kumar KS
        • Rajagopal MR
        • Naseema AM
        Intravenous morphine for emergency treatment of cancer pain.
        Palliat Med. 2000; 14: 183-188
        • Mercadante S.
        Small repeated boluses are unreliable to provide rapid analgesia with intravenous morphine titration and mislead conversion ratio to oral morphine.
        Ann Oncol. 2018; 29: 2147-2148
        • Hagen NA
        • Elwood T
        • Ernst S.
        Cancer pain emergencies: a protocol for management.
        J Pain Symptom Manage. 1997; 14: 45-50
        • Lee KH
        • Kang JU
        • Oh HS
        • et al.
        Intravenous oxycodone versus intravenous morphine in cancer pain: a randomized, open-label, parallel-group, active-control study.
        Pain Res Manag. 2017; 9741729
        • Yoshimoto T
        • Ryu E
        • Tomiyasu S
        • et al.
        Efficacy and safety of oxycodone injection for relieving cancer pain: a study in Japan consisting of two open trials for intravenous and subcutaneous administration.
        Biol Pharm Bull. 2018; 41: 850-857
        • Nakajima N.
        Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain.
        J J Clin Oncol. 2019; 49: 1061-1064
        • Klepstad P
        • Kaasa S
        • Skauge M
        • Borchgrevink PC.
        Pain intensity and side effects during titartion of morphine to cancer patients using a fixed schedule dose escalation.
        Acta Anaesthesiol Scand. 2000; 44 (656–6)