Advanced Cancer Pain Research Articles

Calculating worldwide needs for morphine for pain in advanced cancer and proportions feasibly met by country estimates of requirements and consumption. Retrospective, time-series analysis (1997-2017).

Lack of access to therapeutic opioids continuing causes global health inequalities. Access to morphine for symptom control is regulated under the terms of the Single Convention on Narcotics, countries must submit annual morphine requirement estimates and report consumption to the International Narcotics Control Board (INCB). INCB indicates access to morphine is increasing, however, estimated needs are unreported so changing proportions of needs feasibly met by requirements and consumption are unknown. Retrospective time series-analysis taking cross-sections every five years of gaps between calculated needs for morphine for people who die from cancer and total treatable using estimates of requirements and consumption (1997, 2002, 2007, 2012, 2017). We calculated need using INCB-recommended methods (80% of people who die from cancer require 67.5mg of morphine daily for 90 days (6.075g)) for countries reporting estimates and consumption using Global Burden of Disease cancer deaths by country. Gaps between calculated need and total treatable population using estimates and consumption were calculated. We report proportions of need feasibly met by estimates and consumption for included countries, by World Bank Income group. Global availability of morphine increased, from estimates sufficient to treat 86% of calculated needs in 1997, to 701% in 2017. However, proportion of countries estimating requirements feasibly meeting >100% of calculated needs rose only from 16% to 30%. Almost all Low-and-Middle-Income Countries submitted inadequate estimates with little change in 20 years. Consumption was lower than calculated needs at all time-points. Very few countries reported consumption greater than their estimate of requirement. Most countries submitted morphine estimates insufficient to meet analgesic needs of people who died from cancer. Estimates of requirements contextualise future Consumption, and increases in adequacy of estimates and consumption were minimal over 20 years. Annual publication of calculated morphine needs alongside estimates and consumption may be a key step to drive countries' accountabilities.

SY28-1 Cancer pain treatment in Japan: current perspectives and challenge

66.4% of patients with advanced cancer experience cancer pain, of which about 80% have moderate or higher pain. Since 2008, over 130,000 doctors completed a nationwide palliative care education program (PEACE project) and the knowledge of in cancer pain treatment among physicians in Japan is improved. However, a nationwide survey for bereaved family members revealed that about 40% of cancer patients had pain in the last month prior their death. A refractory cancer pain, which is not to alleviate with basic cancer pain therapy with opioid, still threatens the quality of life of the patients.

High incidence of severe pain is associated with low opioid availability in patients with advanced cancer: a nationwide questionnaire survey in Japan

Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid consumption in Japan is still extremely low compared with that in other countries. We investigated the current situation of pain control and opioid consumption in patients with advanced cancer in Japan. This was a national cohort study done in Japan after approval by the ethical committee of our institute the University of Tokyo Hospital (reference 202176NI). Between Sept 1, 2021, and Nov 15, 2021, caregivers from 2000 comprehensive support centres nationwide answered the web-based questionnaire survey asking for details about their assigned patients who died of end-stage cancer. The survey included the questionnaire of pain intensity and opioid prescription. Data from 1034 responders were retrieved, of which 1000 completed questionnaires for patients who died of end-stage cancer were considered valid. Of answers (excluding "I don't want to answer", "unknown", and "not applicable"), 254 (38%) of 665 patients complained of severe-to-intolerable cancer-related pain. Opioids were only available for 486 (77%) of 633 patients. The opioid adequacy rate, as defined by WHO, was negatively correlated with severe to intolerable pain (p=0·037). Only 344 (47%) of 730 patients with advanced cancer were supported by palliative care specialists. Pain control for advanced cancer pain is insufficient in Japan. In comparison with worldwide levels, opioid prescription is underused in clinical practice. The low availability of opioids can be improved by introduction of quality palliative care support for patients with advanced cancer. This study was funded by the authors and by Shionogi (Osaka, Japan), Nippon Zoki Pharmaceutical (Osaka, Japan), and Heartfelt (Kumamoto, Japan).

Consensus-Based Guidance on Opioid Management in Individuals With Advanced Cancer-Related Pain and Opioid Misuse or Use Disorder

Opioid misuse and opioid use disorder (OUD) are important comorbidities in people with advanced cancer and cancer-related pain, but there is a lack of consensus on treatment. To develop consensus among palliative care and addiction specialists on the appropriateness of various opioid management strategies in individuals with advanced cancer-related pain and opioid misuse or OUD. For this qualitative study, using ExpertLens, an online platform and methodology for conducting modified Delphi panels, between August and October 2020, we conducted 2 modified Delphi panels to understand the perspectives of palliative and addiction clinicians on 3 common clinical scenarios varying by prognosis (weeks to months vs months to years). Of the 129 invited palliative or addiction medicine specialists, 120 participated in at least 1 round. A total of 84 participated in all 3 rounds. Consensus was investigated for 3 clinical scenarios: (1) a patient with a history of an untreated opioid use disorder, (2) a patient taking more opioid than prescribed, and (3) a patient using nonprescribed benzodiazepines. Participants were mostly women (47 [62%]), White (94 (78 [65%]), and held MD/DO degrees (115 [96%]). For a patient with untreated OUD, regardless of prognosis, it was deemed appropriate to begin treatment with buprenorphine/naloxone and inappropriate to refer to a methadone clinic. Beginning split-dose methadone was deemed appropriate for patients with shorter prognoses and of uncertain appropriateness for those with longer prognoses. Beginning a full opioid agonist was deemed of uncertain appropriateness for those with a short prognosis and inappropriate for those with a longer prognosis. Regardless of prognosis, for a patient with no medical history of OUD taking more opioids than prescribed, it was deemed appropriate to increase monitoring, inappropriate to taper opioids, and of uncertain appropriateness to increase the patient's opioids or transition to buprenorphine/naloxone. For a patient with a urine drug test positive for non-prescribed benzodiazepines, regardless of prognosis, it was deemed appropriate to increase monitoring, inappropriate to taper opioids and prescribe buprenorphine/naloxone. The findings of this qualitative study provide urgently needed consensus-based guidance for clinicians and highlight critical research and policy gaps.

Expert Panel Consensus on Management of Advanced Cancer-related Pain in Individuals with Opioid Use Disorder

Develop consensus on the appropriateness of cancer pain management strategies in individuals with co-occurring advanced cancer and OUD. Three-round modified-Delphi process with two cases: patient with advanced cancer, pain and OUD treated with buprenorphine/naloxone or methadone. Participants rated management strategies in Round 1, discussed results in Round 2, and provided final responses in Round 3 in an online modified-Delphi panel. Participants included experts in palliative care, addiction, or both, recruited by email from palliative care and addiction-focused professional groups, lists from prior studies, and snowball sampling. Of 120 experts, the majority of whom held MD or DO degrees (115, 96%), 70% participated in all rounds. For a patient with OUD on buprenorphine/naloxone, it was deemed appropriate to continue buprenorphine/naloxone with three-times-per-day dosing. Continuing buprenorphine/naloxone and adding a full-agonist opioid was deemed appropriate for patients with a prognosis of weeks-months, and of uncertain appropriateness for a prognosis of months-years. For a patient with OUD on methadone dispensed at a methadone clinic, it was deemed appropriate to take over prescribing and dose 2-3x/day. Continuing methadone daily while adding another full-agonist opioid was deemed appropriate for patients with a prognosis of weeks-months and of uncertain appropriateness for a prognosis of months-years. This qualitative study, urgently needed, consensus-based guidance for clinicians, and highlighted critical research and policy gaps needed to facilitate implementation. Findings underscore the importance of additional research to investigate optimal dosing of buprenorphine/naloxone and methadone in patients with advanced cancer pain and OUD, and factors influencing the preferred choice. Grant support from the Cambia Health Foundation.

Association of polymorphisms in ARRB2 and clinical response to methadone for pain in advanced cancer.

Background: The prescription of methadone in advanced cancer poses multiple challenges due to the considerable interpatient variation seen in effective dose and toxicity. Previous reports have suggested that ARRB2 influences the response to methadone in opioid substitution therapy. Associations with opioid response for pain management in advanced cancer are conflicting, with no studies including methadone as the primary intervention. Methods: In a prospective, multicenter, open-label dose-individualization study, we investigated whether polymorphisms in ARRB2 were associated with methadone dose requirements and pain severity. Results: Significant associations were found for rs3786047, rs1045280, rs2036657 and pain score. Conclusion: While studies are few and the sample size small, ARRB2 genotyping may assist in individualized management of the most feared symptom in advanced cancer.

The Managing Advanced Cancer Pain Together (MACPT) conversation tool: an evaluation of use in clinical practice.

Aim: To investigate use of the 'Managing Advanced Cancer Pain Together' conversation tool between individuals with advanced cancer and healthcare professionals (HCPs) during routine consultations. Methods: Twenty-one patients and six HCPs completed questionnaires before and after use of the tool (at their routine consultation 1 and consecutive consultation 2, respectively). Results: Patients and HCPs were satisfied with communication during both consultations. When using the tool, patients most frequently selected physical pain descriptors (95.2%), followed by emotional (81.0%), social (28.6%) and spiritual (28.6%) descriptors. Patients found the tool useful, stating that it helped them describe their pain. HCPs considered the tool difficult to incorporate into consultations. Conclusion: The study highlighted the need to consider the various aspects of cancer pain.

Morphine Self-controlled Analgesia Pump Intravenous Pump into the Treatment of Advanced Cancer Pain Nursing Intervention

Morphine Self-controlled Analgesia Pump Intravenous Pump into the Treatment of Advanced Cancer Pain Nursing Intervention

C-Reactive Protein and Its Relationship with Pain in Patients with Advanced Cancer Cachexia: Secondary Cross-Sectional Analysis of a Multicenter Prospective Cohort Study.

Background: Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer.Objectives: To investigate the relationship between serum levels of CRP and subtypes of pain.Design: A secondary cross-sectional analysis of a prospective cohort study.Setting/Subjects: Patients with advanced cancer admitted to 23 palliative care units in Japan.Measurements: Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal–Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated.Results: We divided 1513 patients into four groups: low CRP (n = 234), moderate CRP (n = 513), high CRP (n = 352), and very high CRP (n = 414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (p < 0.001) and 0.16 (p < 0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 [95% CI 1.14–2.88], p = 0.01; 1.74 [95% CI 1.18–2.57], p = 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain.Conclusions: The results indicated direct relationships between CRP, pain NRS, and pain IPOS.

Leveraging mobile health technology and research methodology to optimize patient education and self-management support for advanced cancer pain.

Patient education is critical for management of advanced cancer pain, yet the benefits of psychoeducational interventions have been modest. We used mobile health (mHealth) technology to better meet patients' needs. Using the Agile and mHealth Development and Evaluation Frameworks, a multidisciplinary team of clinicians, researchers, patients, and design specialists followed a four-phase iterative process to develop comprehensive, tailored, multimedia cancer pain education for a patient-facing smartphone application. The target population reviewed the content and provided feedback. The resulting application provides comprehensive cancer pain education spanning pharmacologic and behavioral aspects of self-management. Custom graphics, animated videos, quizzes, and audio-recorded relaxations complemented written content. Computable algorithms based upon daily symptom surveys were used to deliver brief, tailored motivational messages that linked to more comprehensive teaching. Patients found the combination of pharmacologic and behavioral support to be engaging and helpful. Digital technology can be used to provide cancer pain education that is engaging and tailored to individual needs. A replicable interdisciplinary and patient-centered approach to intervention development was advantageous. mHealth interventions may be a scalable approach to improve cancer pain. Frameworks that merge software and research methodology can be useful in developing interventions.

The Effect of Dezocine Combined with Oxycodone in the Treatment of Advanced Lung Cancer with Bone Metastasis and Severe Cancer Pain on the Numerical Rating Scale Score of Patients

The effect of dezocine combined with oxycodone on the pain score (numerical rating scale score) of patients with severe cancer pain caused by bone metastasis of advanced lung cancer was analyzed. The patients were divided into two groups with 50 cases in each group. The control group was given intramuscular injection of dezocine for analgesia and the observation group was given oral oxycodone hydrochloride controlled release tablets on the basis of intramuscular injection of dezocine for analgesia. The pain relief rate and analgesic efficiency of the observation group were better than those of the control group and the numerical rating scale score was lower than that of the control group. The number of burst pain in the observation group was less than that in the control group, the stable time of first pain control was shorter than that in the control group and the increase time of 24 h sleep was longer than that in the control group, with statistical significance. After treatment, the overall health status score, functional score and symptomatic score of the two groups were significantly higher than those before treatment. Dezocine combined with oxycodone in the treatment of severe cancer pain in advanced lung cancer with bone metastasis can effectively relieve pain, regulate the expression of pain factors and improve the quality of life.

Stereotactic Radiosurgery Hypophysectomy for Palliative Treatment of Refractory Cancer Pain: A Historical Review and Update.

Medically refractory pain in those with advanced cancer significantly reduces one’s quality of life. Therefore, palliative interventions to mitigate cancer pain and reduce opioid requirements are necessary to reduce patient suffering and opioid-induced side effects. Hypophysectomy, a largely forgotten pain procedure with several technical variations, has been repeatedly studied in small series with encouraging results, though historically has been fraught with complications. As a result, the minimally invasive and more tolerable stereotactic radiosurgery (SRS) hypophysectomy has resurfaced as a possible treatment for cancer-related pain. While the mechanism of pain relief is not entirely understood, the hypothalamohypophyseal axis appears to play an essential role in pain perception and transmission and involves C fiber signal processing and downstream modulation of the brainstem and spinal cord via the hypothalamus. This review highlights the role of hypophysectomy in alleviating advanced cancer pain, both in hormonal and nonhormonal malignancy and the current mechanistic understanding of pain relief for the three primary hypophysectomy modalities used historically: surgical and chemical adenolysis, as well as the more recent, SRS hypophysectomy. Given the lack of high-quality evidence for stereotactic radiosurgery hypophysectomy, there is a need for further rigorous and prospective clinical studies despite its ideal and noninvasive approach.

Morphine promotes tumorigenesis and cetuximab resistance via EGFR signaling activation in human colorectal cancer.

Morphine, a mu-opioid receptor (MOR) agonist, has been extensively used to treat advanced cancer pain. In particular,in patients with cancer metastasis, both morphine and anticancer drugs are given simultaneously. However, evidence showed that morphine might be a risk factor in promoting the tumor's malignant potential. In this study, we report that treatment with morphine could activate MOR and lead to the promotion of proliferation, migration, and invasion in HCT116 and DLD1 colorectal cancer (CRC) cells with time-concentration dependence. Moreover, morphine can also contribute to cetuximab's drug resistance, a targeted drug widely used to treat advanced CRC by inducing the activation of epidermal growth factor receptor (EGFR). The cell phenotype includes proliferation, migration, invasion, and drug resistance, which may be reversed by MOR knockdown or adding nalmefene, the MOR receptor antagonist. Receptor tyrosine kinase array analysis revealed that morphine selectively induced the transactivation of EGFR. EGFR transactivation resulted in the activation of ERK1/2 and AKT. In conclusion, morphine induces the transactivation of EGFR via MOR. It activates the downstream signal pathway AKT-MTOR and RAS-MAPK, increases proliferation, migration, and invasion, and promotes resistance to EGFR inhibitors in a CRC cell line. Furthermore, we verified that EGFR inhibition by cetuximab strongly reversed the protumoral effects of morphine in vitro and in vivo. Collectively, we provide evidence that morphine-EGFR signaling might be a promising therapeutic target for CRC patients, especially for cetuximab-resistant CRC patients.

Initiation of Intrathecal Drug Delivery Dramatically Reduces Systemic Opioid Use in Patients With Advanced Cancer

Pain is common in cancer, affecting more than 70% of patients with advanced disease. Intrathecal drug delivery systems (IDDS) are a well-established treatment for patients with refractory cancer pain, improving pain control and reducing associated side effects. To date, details of systemic opioid use before and after IDDS implant have not been reported. We conducted a retrospective review of patients at Huntsman Cancer Institute-University of Utah treated with IDDS for cancer pain from May 2014 to May 2018. Oral, transdermal, and parenteral opioid use before IDDS implant was compared to use 30 days postoperatively. A total of 173 patients were included, 93% with stage IV disease. The pre-implant median daily oral morphine equivalent (OME) was 240 mg (interquartile range 130-390, range 0-2616 mg). OME doses >200 mg/day were required by 57% of patients, and >500 mg OME by 19% of patients. The post-implant median OME was 0 mg (interquartile range 0-0, range 0-480 mg) and 82.6% of patients discontinued systemic opioids completely. 11.0% of patients used <100 mg OME, and only 1.7% of patients used >200 mg OME. Mean OME decreased by 94% following IDDS implant (p < 0.0001) and all patients who continued to use systemic opioids required a lower OME compared to pre-implant. In the largest cohort of patients with advanced cancer and refractory pain treated with IDDS, implantation was associated with a dramatic reduction in systemic opioid use 30 days postoperatively, with a large majority of patients discontinuing systemic opioids. Those patients that continued systemic opioids utilized significantly lower doses as compared to their pre-implant dose.

Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol

Cancer pain, one of the most common symptoms for patients with advanced cancer, is often refractory to maximal medical therapy. A controlled clinical trial is needed to provide definitive evidence to support the use of ablative procedures such as cordotomy for patients with medically refractory cancer pain. To assess the efficacy of cordotomy for patients with unilateral advanced cancer pain using a controlled clinical trial study design. The secondary objectives are to define the patient experience of cordotomy for medically refractory cancer pain as well as to determine the utility of magnetic resonance imaging as a non-invasive biomarker for successful cordotomy. We will undertake a single-institution, double-blind, sham-controlled clinical trial of cordotomy in patients with refractory cancer pain. Patients in the cordotomy arm will undergo a percutaneous computed tomography-guided cordotomy at C1-C2, while patients in the control arm will undergo a similar procedure where the needle will not penetrate the thecal sac. The primary endpoint will be the reduction in pain intensity, as measured by the Edmonton Symptoms Assessment Scale. We expect that patients randomized to cordotomy will have a significantly greater reduction in pain intensity than those patients randomized to the control surgical intervention. This randomized clinical trial comparing cordotomy with a control intervention will provide the level of evidence necessary to determine whether cordotomy should be the standard of care intervention for patients with advanced cancer pain.

Acetaminophen in Patients Receiving Strong Opioids for Cancer Pain

The mainstay of treatment in advanced cancer pain is opioids; however, non-opioid medications such as acetaminophen continue to be included in guidelines despite a lack of clear, convincing evidence for their use. The aim of our study was to determine if acetaminophen improves pain control or reduces opioid utilization in hospitalized patients receiving strong opioids for cancer pain managed by the palliative care consult service (PCCS). We carried out at single-center retrospective cohort study of 194 adult cancer patients seen by the PCCS and who received strong opioids. Patients who received acetaminophen during their admission were compared to those who did not. The primary outcome was a 30% reduction in average daily pain score from admission to discharge using a numeric rating scale. There was no difference between groups in achieving a 30% reduction in pain (35.8% vs. 35.4%, adjusted odds ratio 0.87, 95% confidence interval [CI] 0.46 to 1.63). Acetaminophen was associated with a longer LOS (8 days vs. 6 days, adjusted relative risk 1.67, 95% CI 1.30 to 2.15). In this study of cancer patients receiving strong opioids, acetaminophen use was not associated with improved pain control or reduced opioid utilization, but was associated with a greater LOS.

Clinical observation of filiform fire needling on moderate and severe pain in advanced cancer

To evaluate the clinical effect of filiform fire needling on moderate and severe pain in advanced cancer. A total of 66 patients with moderate and severe pain in advanced cancer were randomly divided into an observation group (34 cases, 4 cases dropped off) and a control group (32 cases, 2 cases dropped off). The two groups were treated with oral analgesics continuously for 4 weeks. The moderate pain patients was given bucinnazine hydrochloride tablets (starting at 30 mg, once every 6 hours, increasing by 30%-50% until the titration volume was reached), and the severe pain patients were given oxycodone hydrochloride sustained-release tablets (starting at 20 mg every 12 hours and increasing by 25%-50% until the titration volume was reached). The observation group was cooperated with filiform fire needling at ashi point, Zusanli (ST 36), Liangqiu (ST 34), Qihai (CV 6), Guanyuan(CV 4), Quchi (LI 11) and Waiguan (TE 5) once every other day for 4 weeks. The changes of numerical rating scales (NRS) scores were observed in both groups before and after treatment, and the amount of analgesics and the incidence of adverse reactions were recorded. The clinical effects in the two groups were evaluated. The effective rate was 90.0% (27/30) in the observation group, which was higher than 66.7% (20/30) in the control group (P<0.05). After treatment, the NRS scores of both groups were lower than those before treatment (P<0.05), and the reducing degree in the observation group was larger than that in the control group (P<0.05). The average dosage of bunarizine hydrochloride tablets and oxycodone hydrochloride sustained release tablets to titration volume in the observation group was less than that in the control group (P<0.05). The incidence of adverse reactions was 23.3% (28/120) in the observation group, which was lower than 44.2% (53/120) in the control group (P<0.05). Filiform fire needling can alleviate pain symptoms of patients with moderate and severe pain in advanced cancer, reduce the amount of analgesics, and decrease the incidence of adverse reactions.

Cannabis and cannabinoids in cancer pain management.

An increasing number of patients are turning to cannabis and cannabinoids for management of their palliative and nonpalliative cancer pain and other cancer-related symptoms. Canadians have a legal framework for access to medical cannabis, which provides a unique perspective in a setting lacking robust clinical evidence. This review seeks to delineate the role of cannabis and cannabinoids in cancer pain management and offers insight into the Canadian practice. A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased. Good preclinical animal data and a large body of observational evidence point to the potential efficacy of cannabinoids for cancer pain management. However, there are relatively weak data pointing to clinical efficacy from clinical trial data to date. In Canada, the burgeoning cannabis industry has driven the population to embrace a medicine before clinical evidence. There remains a need for high-quality randomized controlled trials to properly assess the effectiveness and safety of medical cannabis, compared with placebo and standard treatments for cancer-related symptoms.

Health Informatics of Oxycodone Hydrochloride Sustained-Release Tablets for Cancer Pain Treatment with Support of Computed Tomography Diagnosis

Objective: The purpose of this study is to analyze the medical value of oxycodone hydrochloride sustainedrelease tablets in the treatment of advanced cancer pain in adults using biostatistics and computed tomography (CT). Methods: The efficacy, pain relief and adverse reactions of oxycodone hydrochloride sustained-release tablets in 100 patients with moderate to severe adult cancer pain were retrospectively analyzed. To compare the effects of gender, first-visit pain degree, pain type and metastasis on the effectiveness and pain relief. VAS score decreased by 25.0% or more is effective for treatment, in which pain disappeared completely for complete relief, VAS score decreased by 75.0% or more for obvious relief, VAS score decreased by 50.0%–74.9% for moderate relief, VAS score decreased by 25.0%–49.9% for mild relief, and VAS score decreased by less than 25.0% for no relief. Results: The pain relief rate was 93%. There were 12 cases of complete relief, 24 cases of obvious relief (32%), 23 cases of moderate relief (31%), 10 cases of mild relief (14%) and 5 cases of no relief (7%). The incidence of adverse reactions in patients was 56% constipation, 40% nausea and 76% vomiting. After 4 weeks, the incidence of adverse reactions in patients was 24% constipation, 13% nausea and 43% vomiting. Furthermore, CT image analysis shows that oxycodone hydrochloride sustained-release tablets has obvious therapeutic effect on cancer. Discussion: High-dose oxycodone sustained-release tablets are effective in the treatment of patients with advanced cancer pain. It can relieve the pain of patients, and has high safety. This can be verified based on our health informatics analysis and CT image diagnosis. Conclusion: Oxycodone hydrochloride sustained release tablets are effective and safe in the outpatient treatment of moderate and severe cancer pain in adults, and have better control effect on moderate cancer pain patients, which is worthy of further application and promotion for clinical use.

An oro-buccal nanoparticle delivered cannabis medicine for pain management in cancer: A clinical trial in progress.

TPS12127 Background: Cannabinoid molecules derived from Cannabis sativa L. have been posited to ameliorate conditions, including pain, chemotherapy induced nausea and multiple sclerosis associated spasticity. The clinical use of cannabinoids refers to a wide variety of formulations and extracts that may contain different active ingredients and adulterants as well as inter batch variability. Novel matrix formulations (e.g., water-soluble nanoparticles) for cannabis delivery may add further efficacy and tolerability to standard routes of administration (e.g., oral / gastrointestinal, inhaled, sublingual). This is further emphasized by the dysbiotic effects on the intestinal microbiome reported for oral formulations of medicinal cannabis, and which resulted in reduced efficacy. Similar results have been reported for other psychotropic compounds, such as alcohol and nicotine. Therapeutic use of cannabinoid formulations may be mode of delivery dependent in order to achieve safe, tolerable and effective doses. Methods: A water soluble oro-buccal nanoparticle spray with a racemic 1:1 mixture of Delta9Tetrahydrocannabinol (D9THC) and Cannabidiol (CBD), which bypasses the gastrointestinal system and first pass metabolism by accessing the systemic circulation via the facial lymphatics system, was investigated in patients with advanced cancer and unrelieved pain in a single ascending dose and multiple ascending dose in a first-in-human study. Results: The THC / CBD combination delivered as a submicron particle demonstrated safety, tolerability and a pharmacokinetic profile suitable for maintenance analgesic therapy. Preliminary analysis found an overall (n = 25) improvement in pain scores, especially in the subgroup of patients with bone metastases (n = 8), who obtained a greater than 30% average reduction in pain severity. 1 Clinical trial information: ACTRN12617001480370 .