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Supportive Care in Cancer

, Volume 27, Issue 1, pp 33–42 | Cite as

Subcutaneous or intravenous opioid administration by patient-controlled analgesia in cancer pain: a systematic literature review

  • Lisa Nijland
  • Pia Schmidt
  • Michael Frosch
  • Julia Wager
  • Bettina Hübner-Möhler
  • Ross Drake
  • Boris Zernikow
Review Article

Abstract

Context

Opioids administered by various routes are a mainstay of tumour-related pain management. Subcutaneous or intravenous patient-controlled analgesia (PCA) with opioids is an appropriate and safe form of treatment for postoperative pain but studies on this form of administration are sparse in the setting of cancer pain despite widespread use.

Objective

To evaluate the published studies on opioids administered by subcutaneous and intravenous patient-controlled analgesia for patients with cancer pain.

Methods

Articles were identified from the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 7, 2016), PubMed (Medline; 1975 to 2016) and EMBASE (1974 to 2016). Additional reports were identified from the reference lists of retrieved papers. Studies based on original data with a focus on intravenous or subcutaneous PCA administration of opioids in patients suffering from cancer-related pain were selected. The language was restricted to Dutch, English or German. Predefined information was extracted depending on the topic.

Results

Fifty studies published since 1980 met the inclusion criteria. A wide range of study designs, study quality and research objectives were observed. The studies indicated use of standard or by proxy PCA in the inpatient and outpatient setting were safe and useful while significant adverse effects were rarely observed.

Conclusion

This systematic review of the current evidence suggests PCA can be appropriately used in a wide range of clinical situations.

Keywords

Patient-controlled analgesia Cancer Pain Opioid Review 

Notes

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2018_4368_MOESM1_ESM.docx (59 kb)
ESM 1 (DOCX 59.3 kb)

References

  1. 1.
    McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Eccleston C, Finley AG, Goldschneider K, Haverkos L, Hertz S, Ljungman G, Palermo T, Rappaport BA, Rhodes T, Schechter N, Scott J, Sethna NF, Svensson OK, Stinson J, von Baeyer CL, Walker L, Weisman S, White RE, Zajicek A, Zeltzer L (2008) Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain 9(9):771–783PubMedGoogle Scholar
  2. 2.
    O’Connor AB, Turk DC, Dworkin RH, Katz NP, Colucci R, Haythornthwaite JA, Klein M, O’Brien C, Posner K, Rappaport BA, Reisfield G, Adams EH, Balster RL, Bigelow GE, Burke LB, Comer SD, Cone E, Cowan P, Denisco RA, Farrar JT, Foltin RW, Haddox JD, Hertz S, Jay GW, Junor R, Kopecky EA, Leiderman DB, McDermott MP, Palmer PP, Raja SN, Rauschkolb C, Rowbotham MC, Sampaio C, Setnik B, Smith SM, Sokolowska M, Stauffer JW, Walsh SL, Zacny JP (2013) Abuse liability measures for use in analgesic clinical trials in patients with pain: IMMPACT recommendations. Pain 154(11):2324–2334.  https://doi.org/10.1016/j.pain.2013.06.035 PubMedGoogle Scholar
  3. 3.
    Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrer JT, Galer BS, Hewitt DJ, Jadad AR, Katz NP, Kramer LD, Manning DC, McCormick CG, McDermott MP, McGrath PA, Quessy S, Rappaport BA, Robinson JP, Royal MA, Lee S, Stauffer JW, Stein W, Tollett J, Witter J (2003) Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106(337):345Google Scholar
  4. 4.
    Schiessl C, Bidmon J, Sittl R, Griessinger N, Schüttler J (2007) Patient-controlled analgesia (PCA) in outpatients with cancer pain—analysis of 1,692 treatment days. Schmerz 21(1):35–42PubMedGoogle Scholar
  5. 5.
    Reale C, Vernaglione E, Reale CA, Mancini A, Prologo M, Campisi C (2003) Advantages of totally implanted port over impromptu short-term central venous catheter in oncological pain therapy. J Vasc Access 4(2):50–55PubMedGoogle Scholar
  6. 6.
    Sousa AM, de Santana NJ, Guimaraes GM, Cascudo GM, Neto JOB, Ashmawi HA (2014) Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study. Support Care Cancer 22(3):795–801PubMedGoogle Scholar
  7. 7.
    Hayes J, Dowling JJ, Peliowski A, Crawford MW, Johnston B (2016) Patient-controlled analgesia plus background opioid infusion for postoperative pain in children: a systematic review and meta-analysis of randomized trials. Anesth Analg 123(4):991–1003PubMedGoogle Scholar
  8. 8.
    McNicol ED, Ferguson MC, Hudcova J (2015) Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2015 6 (Art. No.: CD003348.). doi: https://doi.org/10.1002/14651858.CD003348.pub3
  9. 9.
    Schiessl C, Schestag I, Sittl R, Drake R, Zernikow B (2010) Rhythmic pattern of PCA opioid demand in adults with cancer pain. Eur J Pain 14(4):372–379PubMedGoogle Scholar
  10. 10.
    Whittemore R, Knafl K (2005) The integrative review: updated methodology. J Adv Nurs 52(5):546–553PubMedGoogle Scholar
  11. 11.
    Ruggiero A, Barone G, Liotti L, Chiaretti A, Lazzareschi I, Riccardi R (2007) Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain. Support Care Cancer 15(5):569–573PubMedGoogle Scholar
  12. 12.
    Bruera E, Brenneis C, Michaud M, Bacovsky R, Chadwick S, Emeno A, MacDonald N (1988) Use of the subcutaneous route for the administration of narcotics in patients with cancer pain. Cancer 62(2):407–411PubMedGoogle Scholar
  13. 13.
    Bruera E, MacMillan K, Hanson J, MacDonald RN (1991) The Edmonton injector: a simple device for patient-controlled subcutaneous analgesia. Pain 44(2):167–169PubMedGoogle Scholar
  14. 14.
    Anghelescu DL, Snaman JM, Trujillo L, Sykes AD, Yuan Y, Baker JN (2015) Patient-controlled analgesia at the end of life at a pediatric oncology institution. Pediatr Blood Cancer 62(7):1237–1244.  https://doi.org/10.1002/pbc.25493 PubMedPubMedCentralGoogle Scholar
  15. 15.
    Baumann TJ, Batenhorst RL, Graves DA (1986) Patient-controlled analgesia in the terminally ill cancer patient. Drug Intell Clin Pharm 20:297–301PubMedGoogle Scholar
  16. 16.
    Bruera E, Michaud M, Brennels C, MacMillan K, MacDonald N (1988) A randomized cross-over trial of patient controlled subcutaneous analgesia versus continuous subcutaneous in patients with cancer pain. Proceedings, annual meeting of the American Society of Clinical Oncology Abs. 1107Google Scholar
  17. 17.
    Bruera E, Velasco-Leiva A, Spachynski K, Fainsinger R, Miller MJ, MacEachern T (1993) Use of the Edmonton injector for parenteral opioid management of cancer pain: a study of 100 consecutive patients. J Pain Symptom Manag 8(8):525–528Google Scholar
  18. 18.
    Citron ML, Johnston-Early A, Boyer M (1986) Patient-controlled analgesia for severe cancer pain. Arch Intern Med 146(4):734–736PubMedGoogle Scholar
  19. 19.
    Citron ML, Kalra JM, Seltzer VL, Chen S, Hoffman M, Walczak MB (1992) Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use. Cancer Investig 10(5):335–341Google Scholar
  20. 20.
    Dev R, Del Fabbro E, Bruera E (2011) Patient-controlled analgesia in patients with advanced Cancer. Should patients be in control? J Pain Symptom Manage iGoogle Scholar
  21. 21.
    Enting RH, Oldenmenger WH, van der Rijt CCD, Wilms EB, Elfrink EJ, Elswijk I, Sillevis Smitt PAE (2002) A prospective study evaluating the response of patients with unrelieved cancer pain to parenteral opioids. Cancer 94(11):3049–1056PubMedGoogle Scholar
  22. 22.
    Flory JH, Wiesenthal AC, Thaler HT, Koranteng L, Moryl N (2016) Methadone use and the risk of hypoglycemia for inpatients with cancer pain. J Pain Symptom Manag 51(1):79–87. e71Google Scholar
  23. 23.
    Kalso E, Heiskanen T, Rantio M, Rosenberg PH, Vainio A (1996) Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study. Pain 67(2):443–449PubMedGoogle Scholar
  24. 24.
    Miser AW, Miser JS, Clark C (1980) Continuous intravenous infusion of morphine sulfate for control of severe pain in children with terminal malignancy. J Pediatr 96:930–932PubMedGoogle Scholar
  25. 25.
    Sabatowski R, Kasper SM, Radbruch L (2002) Patient-controlled analgesia with intravenous L-methadone in a child with cancer pain refractory to high-dose morphine. J Pain Symptom Manag 23(1):3–5Google Scholar
  26. 26.
    Tobias JD, Baker DK (1992) Patient-controlled analgesia with fentanyl in children. Clin Pediatr 31(3):177–179Google Scholar
  27. 27.
    Vanier MC, Labrecque G, Lepage-Savary D, Poulin E, Provencher L, Lamontagne C (1993) Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study. Pain 53(1):27–32PubMedGoogle Scholar
  28. 28.
    Grochow L, Sheidler V, Grossman S, Green L, Enterline J (1989) Does intravenous methadone provide longer lasting analgesia than intravenous morphine? A randomized, double-blind study. Pain 38(2):151–157PubMedGoogle Scholar
  29. 29.
    Moulin DE, Johnson NG, Murray-Parsons N, Geoghegan MF, Goodwin VA, Chester MA (1992) Subcutaneous narcotic infusions for cancer pain: treatment outcome and guidelines for use. CMAJ 146(6):891–897PubMedPubMedCentralGoogle Scholar
  30. 30.
    Anghelescu DL, Faughnan LG, Oakes LL, Windsor KB, Pei D, Burgoyne LL (2012) Parent-controlled PCA for pain management in pediatric oncology: is it safe? J Pediatr Hematol Oncol 34(6):416–420PubMedPubMedCentralGoogle Scholar
  31. 31.
    Anghelescu DL, Zhang K, Faughnan LG, Pei D (2015) The safety and effectiveness of patient-controlled analgesia in outpatient children and young adults with cancer: a retrospective study. J Pediatr Hematol Oncol 37(5):378–382PubMedPubMedCentralGoogle Scholar
  32. 32.
    Goeke H, Herbst M (1993) Patient-controlled analgesia with subcutaneous opoids for out-patients with severe tumour pain. Schmerz 7(1):31–39PubMedGoogle Scholar
  33. 33.
    Mherekumombe MF, Collins JJ (2015) Patient-controlled analgesia for children at home. J Pain Symptom Manag 49(5):923–927Google Scholar
  34. 34.
    Kanagasundaram SA, Cooper MG, Lane LJ (1997) Nurse-controlled analgesia using a patient-controlled analgesia device: an alternative strategy in the management of severe cancer pain in children. J Paediatr Child Health 33:352–355PubMedGoogle Scholar
  35. 35.
    Anghelescu DL, Burgoyne LL, Oakes LL, Wallace DA (2005) The safety of patient-controlled analgesia by proxy in pediatric oncology patients. Anesth Analg 101(6):1623–1627PubMedGoogle Scholar
  36. 36.
    Meuret G, Jocham H (1996) Patient-controlled analgesia (PCA) in the domiciliary care of tumour patients. Cancer Treat Rev 22(Supplement A):137–140PubMedGoogle Scholar
  37. 37.
    Swanson G, Smith J, Bulik CM (1989) Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117 patients. J Clin Oncol 7(12):1903–1908PubMedGoogle Scholar
  38. 38.
    Kerr IG, Sone M, De Angelis C, Iscoe N, Mackenzie R, Schuellert T (1988) Continuous narcotic infusion with patient-controlled analgesia for chronic cancer pain in outpatients. Ann Intern Med 108(4):554–557PubMedGoogle Scholar
  39. 39.
    Wagner J, Souders G, Coffman L, Horvath J (1989) Management of chronic cancer pain using a computerized ambulatory patient-controlled analgesia pump. Hosp Pharm 24(8):639–640 642-634PubMedGoogle Scholar
  40. 40.
    Lux E, Heine J (2011) Home care treatment of cancer pain patients with patient-controlled analgesia (PCA). Schmerz 25(6):663–667PubMedGoogle Scholar
  41. 41.
    Schiessl C, Gravou C, Zernikow B, Sittl R, Griessinger N (2008) Use of patient-controlled analgesia for pain control in dying children. Support Care Cancer 16(5):531–536PubMedGoogle Scholar
  42. 42.
    Fitzgibbon DR, Ready LB (1997) Intravenous high-dose methadone administered by patient controlled analgesia and continuous infusion for the treatment of cancer pain refractory to high-dose morphine. Pain 73(2):259–261PubMedGoogle Scholar
  43. 43.
    Juba KM, Wahler RG, Daron SM (2013) Morphine and hydromorphone-induced hyperalgesia in a hospice patient. J Palliat Med 16(7):809–812PubMedGoogle Scholar
  44. 44.
    Goeke H, Herbst M (1995) Patient-controlled analgesia in outpatients with severe cancer pain. Schmerz 9(2):89–92PubMedGoogle Scholar
  45. 45.
    Gavrin JR, McMenamin EM (2008) Pain management in palliative care oncology patients. Curr Pain Headache Rep 12(4):257–261PubMedGoogle Scholar
  46. 46.
    Bruera E (1989) The use of subcutaneous patient controlled analgesia. J Pain Symptom Manag 4(2):97–100Google Scholar
  47. 47.
    Dworkin RH, Turk DC, Peirce-Sandner S, Baron R, Bellamy N, Burke LB, Chappell A, Chartier K, Cleeland CS, Costello A (2010) Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations. Pain 149:177–193PubMedGoogle Scholar
  48. 48.
    Turk DC, Dworkin RH, McDermott B, Bellamy N, Burke LB, Chandler J, Cleeland CS, Cowan P, Dimitrova R, Farrar JT, Hertz S, Heyse JF, Iyengar S, Jadad A, Jay GW, Jermano JA, Katz NP, Manning DC, Martin S, Max MB, McGrath P, McQuay H, Quessy S, Rappaport BA, Revicki D, Rothman M, Stauffer JW, Svensson OK, White RE, Witter J (2008) Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Pain 139:485–493PubMedGoogle Scholar
  49. 49.
    Turk DC, Dworkin RH, Burke L, Gershon R, Rothman R, Scott J, Allen RR, Atkinson JH, Chandler J, Cleeland C, Cowan P, Dimitrova R, Dionne R, Farrar JT, Haythornwaite JA, Hertz S, Jadad AR, Jensen MP, Kellstein D, Kerns RD, Manning DC, Martin S, Max MB, McDermott MP, McGrath PA, Moulin DE, Nurmikko T, Quessy S, Raja S, Rappaport BA, Rauschkolb C, Robinson JP, Royal MA, Simon L, Stauffer JW, Stucki G, Tollett J, von Stein T, Wallace MS, Wernicke J, White RE, Williams AC, Witter J, Wyrwich KW (2006) Developing patient-reported outcome measures for pain clinical trials: IMMPACT recommendations. Pain 125:208–215PubMedGoogle Scholar
  50. 50.
    Grond S, Zech D, Lehmann KA, Radbruch L, Breitenbach H, Hertel D (1997) Transdermal fentanyl in the long-term treatment of cancer pain: a prospective study of 50 patients with advanced cancer of the gastrointestinal tract or the head and neck region. Pain 69(1–2):191–198PubMedGoogle Scholar
  51. 51.
    Kornick CA, Santiago-Palma J, Khojainova N, Primavera LH, Payne R, Manfredi PL (2001) A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl. Cancer 92(12):3056–3061PubMedGoogle Scholar
  52. 52.
    Kornick CA, Santiago-Palma J, Schulman G, O'Brian PC, Weigand S, Payne R, Manfredi PL (2003) A safe and effective method for converting patients from transdermal to intravenous fentanyl for the treatment of acute cancer-related pain. Cancer 97(12):3121–3124PubMedGoogle Scholar
  53. 53.
    Santiago-Palma J, Khojainova N, Kornick C, Fischberg DJ, Primavera LH, Payne R, Manfredi P (2001) Intravenous methadone in the management of chronic cancer pain. Cancer 92(7):1919–1925PubMedGoogle Scholar
  54. 54.
    Radbruch L, Loick G, Schulzeck S, Beyer A, Lynch J, Stemmler M, Lindena G, Lehmann KA (1999) Intravenous titration with morphine for severe cancer pain: report of 28 cases. Clin J Pain 15(3):173–178PubMedGoogle Scholar
  55. 55.
    Zech DFJ, Grond SUA, Lynch J, Dauer HG, Stollenwerk B, Lehmann KA (1992) Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain. A pilot study with 20 terminally ill cancer patients. Pain 50:293–301PubMedGoogle Scholar
  56. 56.
    Zech DFJ, Lehmann KA (1995) Transdermal fentanyl in combination with initial intravenous dose titration by patient-controlled analgesia. Anti-Cancer Drugs 6(3):44–49PubMedGoogle Scholar
  57. 57.
    Björkman R, Ullman A, Hedner J, Group MDS (1993) Morphine-sparing effect of diclofenac in cancer pain. Eur J Clin Pharmacol 44(1):1–5PubMedGoogle Scholar
  58. 58.
    Kalso E, Vainio A, Mattila MJ, Rosenberg PH, Seppälä T (1990) Morphine and oxycodone in the management of cancer pain: plasma levels determined by chemical and radioreceptor assays. Pharmacol Toxicol 67(4):322–328PubMedGoogle Scholar
  59. 59.
    Bruera E, MacMillan K, Kuehn N, Miller MJ (1992) Circadian distribution of extra doses of narcotic analgesics in patients with cancer pain: a preliminary report. Pain 49(3):311–314PubMedGoogle Scholar
  60. 60.
    Schiessl C, Sittl R, Griessinger N, Lutter N, Schuettler J (2008) Intravenous morphine consumption in outpatients with cancer during their last week of life-an analysis based on patient-controlled analgesia data. Support Care Cancer 16(8):917–923PubMedGoogle Scholar
  61. 61.
    Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid?: twenty-four years of experience. Can Fam Physician 56(6):514–517PubMedPubMedCentralGoogle Scholar
  62. 62.
    Franson HE (2010) Postoperative patient-controlled analgesia in the pediatric population: a literature review. AANA J 78(5)Google Scholar
  63. 63.
    Schmidt P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B (2013) Did increased availability of paediatric palliative care lead to improved palliative care outcomes in children with cancer? J Palliat Med 16(9):1034–1039PubMedGoogle Scholar
  64. 64.
    Wolfe J, Grier HE, Klar N, Levin SB, Ellenbogen JM, Salem-Schatz S, Emanuel EJ, Weeks AC (2000) Symptoms and suffering at the end of life in children with cancer. N Engl J Med 342:326–333PubMedGoogle Scholar
  65. 65.
    Dupuis LL, Milne-Wren C, Cassidy M, Barrera M, Portwine C, Johnston DL, Silva MP, Sibbald C, Leaker M, Routh S (2010) Symptom assessment in children receiving cancer therapy: the parents perspective. Support Care Cancer 18(3):281–299PubMedGoogle Scholar
  66. 66.
    Pöder U, Ljungmann G, von Essen L (2010) Parent’s perception of their children’s cancer-related symptoms during treatment: a prospective, longitudinal study. J Pain Symptom Manag 40(5):661–670Google Scholar
  67. 67.
    Kestler SA, LoBiondo-Wood G (2012) Review of symptom experiences in children and adolescents with cancer. Cancer Nurs 35(2):E31–E49PubMedGoogle Scholar
  68. 68.
    Anghelescu D, Faughnan L, Oakes L, Windsor K, Burgoyne L (2011) F280 the safety of parent (proxy)-controlled analgesia aa a pediatric oncology center. Eur J Pain Supplements 5 (1):147Google Scholar
  69. 69.
    Etches RC (1994) Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth 41(2):125–132PubMedGoogle Scholar
  70. 70.
    Cashman J, Dolin S (2004) Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 93(2):212–223PubMedGoogle Scholar
  71. 71.
    Auvil-Novak SE, Novak RD, Smolensky MH, Kavanagh JJ, Kwan JW, Wharton JT (1988) Twenty-four hour variation in self-administration of morphine sulfate (MS) and hydromorphone (H) by post-surgical gynecologic cancer patients. Annu Rev Chronopharm 5:343–346Google Scholar
  72. 72.
    Cerchietti LCA, Navigante AH, Körte MW, Cohen AM, Quiroga PN, Villaamil EC, Bonomi MR, Roth BM (2003) Potential utility of the peripheral analgesic properties of morphine in stomatitis-related pain: a pilot study. Pain 105(1):254–273Google Scholar
  73. 73.
    Graves DA, Batenhorst RL, Bennett RL, Wettstein JG, Griffen WO, Wright BD, Foster TS (1983) Morphine requirements using patient-controlled analgesia: influence of diurnal variation and morbid obesity. Clin Pharm 2(1):49–53PubMedGoogle Scholar
  74. 74.
    Bruguerolle B, Labrecque G (2007) Rhythmic pattern in pain and their chronotherapy. Adv Drug Deliv Rev 59(9–10):883–895PubMedGoogle Scholar
  75. 75.
    Labrecque G, Vanier MC (1995) Biological rhythms in pain and in the effects of opioid analgesics. Pharmacol Ther 68(1):129–147PubMedGoogle Scholar
  76. 76.
    Chassard D, Duflo F, Bouvet L, Boselli E (2007) Chronobiology of postoperative pain: it's time to wake up!/Chronobiologie de la douleur postoperatoire: il est temps de se reveiller ! Can J Anesth 54(9):685–688PubMedGoogle Scholar
  77. 77.
    Hummel T, Kraetsch HG, Loetsch J, Hepper M, Liefhold J, Kobal G (1995) Analgesic effects of Dihydrocodeine and tramadol when administered either in the morning or evening. Chronobiol Int 12(1):62–72PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Lisa Nijland
    • 1
  • Pia Schmidt
    • 1
  • Michael Frosch
    • 1
  • Julia Wager
    • 1
  • Bettina Hübner-Möhler
    • 1
  • Ross Drake
    • 2
  • Boris Zernikow
    • 1
  1. 1.Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of MedicineWitten/Herdecke UniversityDattelnGermany
  2. 2.Starship Children’s HealthAucklandNew Zealand

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