Long-term tolerability and effectiveness of oxymorphone extended release in patients with cancer.

OBJECTIVE: To evaluate the long-term safety, tolerability, and effectiveness of oxymorphone extended release (ER) in patients with cancer-related pain. DESIGN: Post hoc analysis of two-1-year open-label extension studies. SETTING: Multiple US cancer treatment facilities. PATIENTS: Patients with cancer pain who had participated in two short-term crossover comparator trials of oxymorphone ER: one open-label and one double-blind randomized. INTERVENTIONS: Patients who had been taking oxymorphone ER continued the dose established in the previous study. Patients who had been taking a comparator opioid were switched to an equianalgesic dose of oxymorphone ER. All patients underwent individualized oxymorphone ER dose titration to optimize effectiveness and tolerability. ASSESSMENTS: Current, average, worst, and least pain scores were normalized to a 100-point scale. Patients rated treatment on a five-point global assessment of study medication (Poor = 1 to Excellent = 5). All adverse events (AEs) were recorded. RESULTS: Of the 80 patients who entered the extension trials, 26 completed 52 weeks, 7 discontinued owing to loss of effectiveness, and 20 discontinued owing to AEs, most of which were unrelated to study drug. No significant increase in mean (standard deviation [SDD average pain intensity was observed from baseline (30.5 [19.6], 100-point scale) to final visit (35.9 [21.1], p = 0.37). The most common AEs were concomitant disease progression (28.8 percent, n=23), nausea (22.5 percent, n=18), dyspnea (16.3 percent, n=13), fatigue (16.3 percent, n=13), and edema of the lower limb (15 percent, n=12). CONCLUSIONS: In these patients with pain related to cancer, oxymorphone ER was generally well tolerated and provided stable long-term pain control.

Cancer breakthrough pain in the presence of cancer-related chronic pain: fact versus perceptions of health-care providers and patients.

Cancer breakthrough pain is a flare in pain that "breaks through" well-controlled persistent cancer pain. Although the condition is highly prevalent, the concept of cancer breakthrough pain is not well understood and is therefore underdiagnosed and undertreated. The purpose of this review is to examine the roles the health-care practitioner and patient/family caregiver play in the undertreatment of breakthrough pain. A lack of technical knowledge about pain management and pain assessment, attitudes about opioid addiction, and regulatory guidelines influence the manner in which opioids are prescribed. Patients harbor a variety of fears and misconceptions, such as opioid addiction, tolerance, side effects, and the meaning of pain, which can create a barrier to effective communication with their health-care provider regarding their cancer pain management and specifically their breakthrough pain. Identifying these issues gives health-care professionals and patients an opportunity to develop strategies that can improve the treatment of cancer breakthrough pain.