title: European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus?
abstract: This is a systematic review examining the management of opioid-induced central side effects. It has been conducted as part of a larger European Palliative Care Research collaborative review into the use and role of opioids in cancer pain. The review process identified 26 studies that met the inclusion criteria. The overall quality of the data was low and the few recommendations that can be made are weak and require confirmatory studies. The main central side effects examined were sedation, cognitive failure, sleep disturbance and myoclonus. Overall there is limited evidence for the use of methylphenidate in counteracting opioid-induced sedation and cognitive disturbance. No clear recommendations can be made concerning other individual drugs for the management of any of the central side effects examined. Given the lack of available data from this review there need to be further prospective controlled trials to confirm or refute these findings.
authors.affiliation: Division of Mental Health, St Georges University of London, UK. pstone@sgul.ac.uk
authors.forename: Patrick
authors.initials: P
authors.lastname: Stone
authors.forename: Ollie
authors.initials: O
authors.lastname: Minton
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000139:chemically induced / Q000188:drug therapy*; D016292:Procedural Sedation; D004347:Drug Interactions; D005060:Europe; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced; D008774:Methylphenidate / Q000627:therapeutic use; D009207:Myoclonus / Q000139:chemically induced / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D008774:Methylphenidate