Are All Strong Opioids Equal for Chronic Cancer Pain? (note: high % non-responders)

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 randomly assigned to receive oral morphine or oxycodone or transdermal fentanyl or buprenorphine for 28 days

Nevertheless, to our knowledge, this is the biggest randomized trial on opioid treatment in cancer pain.

Moreover, there were many non- or partial responders even though opioids are still widely considered the most effective tools for relieving cancer pain.

Study Design and Patients

This is a multicenter, randomized, open-label, active-controlled, four-arm, of superiority, phase IV clinical trial.

Table 1.  Main demographic and clinical characteristics of the patients at baseline

 Discontinuation from the randomly given opioid mainly included unsuccessful pain relief or severe unmanageable toxicity; this occurred from 27% to 14.5%.

 The variability in the response to opioids does not concern the actual analgesia as such, but the changes of therapy needed to maintain it.
 

Conclusion: The main findings were the similarity in pain control, response rates and main adverse reactions among opioids. Changes in therapy schedules were notable over time. A considerable proportion of patients were nonresponders or poor responders.