title: Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review.
abstract: Side effects can limit opioid dosage and reduce quality of life. The purpose of this systematic review was to assess the management of opioid side effects in the context of cancer pain management or, in the event that no evidence was available for cancer pain, for chronic noncancer pain. The side effects studied were constipation, pruritus, nausea and vomiting, myoclonus, sedation, respiratory depression, and delirium. Opioid rotation to manage side effects was also studied. For each side effect, we searched MEDLINE and the Cochrane Controlled Trials Register and identified 657 possible titles for inclusion. Of these, 67 studies met inclusion criteria for analysis. The lack of well-designed, randomized controlled trials and the heterogeneity of populations and study designs made the drawing of firm conclusions difficult and precluded performance of meta-analysis. The type, strength, and consistency of evidence for available interventions to manage opioid side effects vary from strong (eg, on the use of naloxone to reverse respiratory depression or constipation) to weak (eg, changing from the oral to epidural route of morphine administration to manage sedation). Well-designed trials in the specified populations are required to furnish clinicians with secure evidence on managing opioid side effects successfully.
authors: Department of Anesthesia, New England Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA. EMcNicol@tufts-nemc.org
authors: Ewan
authors: E
authors: McNicol
authors: Nathalie
authors: N
authors: Horowicz-Mehler
authors: Ruth A
authors: RA
authors: Fisk
authors: Kyle
authors: K
authors: Bennett
authors: Maria
authors: M
authors: Gialeli-Goudas
authors: Priscilla W
authors: PW
authors: Chew
authors: Joseph
authors: J
authors: Lau
authors: Daniel
authors: D
authors: Carr
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D002908:Chronic Disease; D003248:Constipation / Q000139:chemically induced; D003693:Delirium / Q000139:chemically induced; D006801:Humans; D009207:Myoclonus / Q000139:chemically induced; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000150:complications* / Q000209:etiology; D011537:Pruritus / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid