title: Spinal opioids in adult patients with cancer pain: a systematic review: a European Palliative Care Research Collaborative (EPCRC) opioid guidelines project.
abstract: BACKGROUND
  A systematic review, undertaken according to an initiative to revise European Association for Palliative Care guidelines on the use of opioids for cancer pain, which aimed to analyse analgesic efficacy and side effects of spinal opioids in adult cancer patients previously treated with systemic opioids.
  
  
  METHODS
  Search strategy elaborated with MeSH terms and words related to cancer, palliative care, pain, spinal route and opioids. PubMed, Embase and Cochrane assessed in Nov 2009. Studies were analysed and classified according to quality of evidence and strength of recommendation.
  
  
  RESULTS
  Out of 2939 abstracts, 44 articles were selected (nine randomized controlled trials (RCTs), two non-randomized cohort studies, 28 uncontrolled prospective studies, and five case series). Relief of pain and/or side effects were reported in 42 articles; however, there were few studies of high quality design (RCTs) and these studies had methodological limitations that reduced their quality of evidence to very low.
  
  
  CONCLUSIONS
  There are few RCTs and these are of very low quality. As a result, they provide weak recommendation for using spinal opioids in adult cancer patients. Further studies are clearly needed.
authors.affiliation: Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark. geana@rh.regionh.dk
authors.forename: Geana Paula
authors.initials: GP
authors.lastname: Kurita
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Per
authors.initials: P
authors.lastname: Sjøgren
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D005060:Europe; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D009369:Neoplasms / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid