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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research

Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research

Published on: January 5, 2024

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

Maike S V Imkamp¹, Maurice Theunissen², Wolfgang Viechtbauer³

¹Center 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.

Journal of Pain and Symptom Management

|June 5, 2024

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.

Conclusion:

The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain.

Keywords:

Cancer pain Drug therapy Pain management Palliative care Statistics

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