Highlights
- •Cancer pain driven by neuropathic mechanisms is believed to be opioid resistant.
- •We find similar opioid requirements in nociceptive and mixed cancer pain patients.
- •Mixed cancer pain may be considered a type of nociceptive pain.
Abstract
Objective
To investigate whether clinical cancer patients with mixed nociceptive–neuropathic
pain are less responsive to opioids than patients with nociceptive pain.
Background
Pain is common in advanced cancer patients. Pain driven by neuropathic mechanisms
is considered to be resistant to opioids. This hypothesis is mainly based on animal
studies and single-dose opioid studies in humans but has not been confirmed in clinical
practice.
Methods
Data were prospectively collected from 240 clinical cancer pain patients using opioids.
Multiple linear regression was used for assessing the associations between the logarithm
of the morphine equivalent dose (MED) at three days after admission (T = 3d) relative
to admission (T = 0d) (logRMED) and type of pain (nociceptive versus mixed pain),
corrected for gender, age, primary cancer site and use of non-opioid and adjuvant
analgesics. As secondary outcome measures, associations between logMED and logPFent
(fentanyl plasma level) at T = 3d and type of pain were assessed.
Results
Pain intensity between T = 0d and T = 3d was significantly and evenly reduced in patients
with nociceptive pain (n = 173) and mixed pain (n = 67). Median (interquartile range) MED was 20 (10–52) and 20 (20–80) mg (T = 0d),
40 (10–67) and 40 (20–100) mg (T = 3d), median PFent (T = 3d) was 1.59 (0.58–3.19)
and 1.38 (0.54–4.39) ng/ml, none of them significantly different, in patients with
nociceptive and mixed pain, respectively. Neither logRMED, logMED (T = 3d), or logPFent
(T = 3d) was significantly associated with type of pain, after correction for confounding
factors.
Conclusions
We conclude that, at least in clinical cancer patients, mixed pain is as responsive
to opioids as nociceptive pain.
Keywords
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Article info
Publication history
Published online: November 12, 2018
Accepted:
September 25,
2018
Received in revised form:
September 22,
2018
Received:
August 11,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
