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How effective are opioids in chronic pain relief?
May 09, 2001Fentanyl skin patches achieve better pain relief and an enhanced quality of life than sustained release oral morphine, say patients with chronic non-cancer pain in a study in this week's BMJ.
Patients with chronic non-cancer pain, requiring continuous treatment with potent opioids, were randomly assigned to two groups to assess their treatment preference, pain control, and quality of life. One group received four weeks of treatment with sustained release oral morphine followed by fentanyl patches for four weeks. The second group received the same treatments but in reverse order.
Of 212 patients, 138 (65%) preferred fentanyl patches, whereas 59 (28%) preferred sustained release oral morphine and 15 (7%) expressed no preference. The main reason given for preferring fentanyl was better pain relief, followed by greater convenience and fewer adverse events. Patients receiving fentanyl also had higher overall quality of life scores than patients receiving morphine. Although the level of adverse events was similar in both treatment groups, more patients experienced constipation with morphine than with fentanyl. These findings confirm that potent opioids can provide satisfactory pain relief for the difficult clinical problem of chronic non-cancer pain, conclude the authors.
In an accompanying editorial, pain specialist Henry McQuay acknowledges that this is a welcome trial in a difficult area, but writes: "Unfortunately the design of the trial means that we have to question the results. Rule one of drug trials that compare different formulations and use subjective outcomes such as patient preference is that the comparison should be done double blind."
However, the authors argue for simple clinical trials based in clinical practice, using outcomes of greater relevance to patients. The ethics of perfect design with placebos and blinding is questionable, especially when such complex trials fail to recruit patients or yield useful results. Treatment options for these patients are limited. As such, this comparative trial may herald a new approach for their care and in ethical clinical trial design.
British Medical Journal (BMJ)
In an accompanying editorial, pain specialist Henry McQuay acknowledges that this is a welcome trial in a difficult area, but writes: "Unfortunately the design of the trial means that we have to question the results. Rule one of drug trials that compare different formulations and use subjective outcomes such as patient preference is that the comparison should be done double blind."
However, the authors argue for simple clinical trials based in clinical practice, using outcomes of greater relevance to patients. The ethics of perfect design with placebos and blinding is questionable, especially when such complex trials fail to recruit patients or yield useful results. Treatment options for these patients are limited. As such, this comparative trial may herald a new approach for their care and in ethical clinical trial design.
British Medical Journal (BMJ)
Cancer Current Events and Cancer News RSSGEN reports on therapeutic potential of microRNA
Researchers around the globe are working on turning microRNAs, over 5,000 of which already have been identified, into novel drugs for a wide range of applications, reports Genetic Engineering & Biotechnology News (GEN).
Caltech-led team provides proof in humans of RNA interference using targeted nanoparticles
A California Institute of Technology (Caltech)-led team of researchers and clinicians has published the first proof that a targeted nanoparticle-used as an experimental therapeutic and injected directly into a patient's bloodstream-can traffic into tumors, deliver double-stranded small interfering RNAs (siRNAs), and turn off an important cancer gene using a mechanism known as RNA interference (RNAi).
Newly identified growth factor promotes stem cell growth, regeneration
Scientists at Duke University Medical Center have identified a new growth factor that stimulates the expansion and regeneration of hematopoietic (blood-forming) stem cells in culture and in laboratory animals.
URI pharmacy researcher finds beneficial compounds in pure maple syrup
Before you dig in to your next stack of French toast or waffles, you might want to pour on pure maple syrup.
Gene is linked to lung cancer development in never-smokers
A five-center collaborative study that scanned the genomes of thousands of "never smokers" diagnosed with lung cancer as well as healthy never smokers has found a gene they say could be responsible for a significant number of those cancers.
Bacteria divide like clockwork
A team of researchers at MIT and the University of California at San Diego has shown how cell division in a type of bacteria known as cyanobacteria is controlled by the same kind of circadian rhythms that govern human sleep patterns.
Feedback loop explains inflammatory effect on intestinal lining
Signals released by immune cells during a bout of inflammatory bowel disease interfere with intestinal cells' ability to regenerate. Yet people with inflammatory bowel diseases have a significantly higher risk of developing colon cancer: a hyper-activation of growth in those same intestinal cells.
Engineers: Weak laser can ignite nanoparticles, with exciting possibilities
University of Florida engineering researchers have found they can ignite certain nanoparticles using a low-power laser, a development they say opens the door to a wave of new technologies in health care, computing and automotive design.
Study details machinery of immune protection against inflammatory diseases like colitis
Scientists report a protein made by a gene already associated with a handful of human inflammatory immune diseases plays a pivotal role in protecting the intestinal tract from colitis.
Transcription Factors May Dictate Differences Between Individuals
Researchers are only beginning to understand how individual variation in gene regulation can have a lasting impact on one's health and susceptibility to certain diseases.
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