Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial

• Published in: Journal of pain research 2024-01, Vol.17, p.1441-1451
• Main Authors: Xiao, Xiaoguang, Sun, Jianhai, Zhang, Dongsheng, Li, Linjun, Zhou, Haibo, Li, Yongjun, Li, Quan, He, Zhongshi, Fu, Yang, Duan, Qiwen, Zheng, Guping, Tang, Ze, Chu, Qian, Chen, Yuan
• Format: Article
• Language: English
• Subjects: Analgesia; Cancer; Cancer pain; Cancer patients; Central nervous system depressants; hydromorphone; Medical research; Medicine, Experimental; Morphine; opioid titration; Original Research; oxycontin tablets; Patient compliance; patient-controlled subcutaneous analgesia
• ISSN: 1178-7090; 1178-7090
• DOI: 10.2147/JPR.S451698

Studies have shown that oral oxycontin tablets can be used for opioid titration. The European Society for Medical Oncology (ESMO) guidelines for adult cancer pain recommend opioid titration through the parenteral route, usually the intravenous or subcutaneous route. Patient-controlled subcutaneous analgesia (PCSA) with hydromorphone needs further evaluation for opioid titration. This prospective multicenter study was designed to compare the efficacy and safety of hydromorphone PCSA with oral oxycontin tablets for opioid titration of cancer pain. Eligible patients with cancer pain were randomly assigned in a 1:1 ratio to the PCSA group or the oxycontin group for dose titration. Different titration methods were given in both groups depending on whether the patient had an opioid tolerance. The primary endpoint of this study was time to successful titration (TST). A total of 256 patients completed this study. The PCSA group had a significantly lower TST compared with the oxycontin group (median [95% confidence interval (CI)], 5.5[95% CI:2.5-11.5] hours vs.16.0 [95% CI:11.5-22.5] hours;