By Ingfei Chen
An Updated Rx for Cancer Pain
By Ingfei Chen
Morphine and its opioid cousins have long been the treatments of choice for moderate to severe cancer pain. New delivery methods have made it easier for patients to get relief, and pain specialists have grown savvier at making the most of the analgesics they have, says pharmacology researcher June Dahl of the University of Wisconsin–Madison.
Opana (oxymorphone hydrochloride) debuted last summer as the fourth long-acting opioid formulation available since MS Contin (morphine sulfate) reached the market in 1984. The long-acting versions have liberated patients from having to pop pills every three or four hours.
Although cancer pain can be kept under steady control with continuous doses of opioids, patients can still experience spikes of debilitating pain. In September 2006, patients got a new defense against this “breakthrough pain” when the U.S. Food and Drug Administration approved Fentora, an effervescent fentanyl tablet. The lozenge dissolves in the mouth in a bubbly reaction, and fast absorption of fentanyl can provide relief within 15 minutes. Fentora’s maker, Cephalon, also markets a fast-acting fentanyl citrate “lollipop” called Actiq.
Methadone is best known as a treatment for heroin addicts, but clinicians have increasingly been prescribing it in low doses for pain relief when patients can’t tolerate morphine’s side effects. Switching to methadone or another opioid—a technique known as opioid rotation—has gained wider use in recent years. Methadone is inexpensive, with longer-lasting effects than morphine, although experts say that adjusting its dosage can be tricky.
CALMING PAIN WITH COMBINATIONS
Neuropathic pain—from nerves damaged by chemotherapy or radiation—sometimes responds poorly to opioids. But research has shown that adding antidepressants or antiepileptic drugs, such as Neurontin (gabapentin), to morphine therapy can offer better pain relief with fewer side effects than treating with the opioid alone. In other studies, localized radiation therapy combined with osteoporosis drugs called bisphosphonates helped reduce bone pain.