Use of oxycodone controlled-release immediately after NSAIDs: a new approach to obtain good pain control

L. Tessaro 1, E. Bandieri 2, G. Costa 3, G. Fornasier 4, V. Iorno 5, C. Pizza 6, G. Pastacaldi 7, G. Micheletto 8

1 Pain and Palliative Care, Unità Locale Socio Sanitaria (ULSS) 8, Asolo (Italy) 2 Unit of Oncology, Carpi e Mirandola Hospital, Modena, Italy 3 Pain Therapy Department, Camposampiero Hospital, Camposampiero (Padova) (Italy) 4 Unit of Pain Therapy and Palliative Care, Belluno (Italy) 5 Pain Therapy Department, Policlinico Mangiagalli Regina Elena, Milan (Italy) 6 Oncology Unit, ASLNA4, San Giuseppe Vesuviano (Italy) 7 Palliative Care and Pain Therapy Unit, Dolce e Misericordia Hospital, Prato (Italy) 8 Unit of Palliative Care, Unità Locale Socio Sanitaria (ULSS) 13, Mirano (Italy)

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• Pharmacology

Abstract. – Introduction: Opioids are recommended as appropriate therapy for the treatment of cancer pain and chronic non-malignant pain. Oxycodone is an alternative agent to its parent compound, morphine, and is available in a controlled-release (CR) formulation that allows convenient twice-daily dosing. The aim of this study was to evaluate the efficacy and tolerability of oxycodone CR as first-line therapy in patients with chronic cancer or non-cancer pain that was not relieved by non-steroidal anti-inflammatory drugs (NSAIDs).
Methods: This was a prospective, open-label, multicentre trial carried out in 8 pain and oncology centres in Italy. Patients (n=309) with NSAID-refractory chronic cancer (55.7%), non-cancer (39.4%) or mixed (4.9%) pain (rating of 4-10 on a numerical rating scale [NRS] from 0-10) were enrolled. Patients were treated with oral oxycodone CR twice daily for at least 28 days. Dosage was individualized for each patient and up-titrated over the first week of treatment. The primary endpoint was reduction in NRS score for pain. Secondary endpoints were tolerability, quality of life and patient assessment of treatment efficacy.
Results: A significant decrease (57%) in pain intensity was recorded during the first week of therapy (decrease in NRS score from 7.85 ± 1.4 to 3.35 ± 1.8; p Conclusions: The results of this study demonstrate the efficacy and tolerability of oxycodone CR in patients with moderate-to-severe pain of a variety of aetiologies and confirm the feasibility and effectiveness of moving directly from step I to step III on the WHO analgesic treatment ladder.

Corresponding Author: Leopoldo Tessaro, MD; e-mail: texleo1@virgilio.it

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