title: Opioid dose titration for severe cancer pain: a systematic evidence-based review.
abstract: Dosing strategies to achieve rapid analgesia in patients with severe or crescendo cancer pain are important. A systematic review of research trials for treatment of severe or crescendo cancer pain was conducted; nine studies were identified. Eight trials were prospective; two were randomized between different dosing strategies. Dosing frequency predicted onset to analgesia regardless of baseline opioid dose. None of the trials were associated with evidence of respiratory depression. The studies all suffered significant methodological problems limiting broad conclusions. Until better data exist, opioid dose titration for severe/crescendo pain will be guided by expert opinion and experience.
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, Cleveland, Ohio, USA. davism6@ccf.org
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.forename: David E
authors.initials: DE
authors.lastname: Weissman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid