{Reference Type}: Journal Article
{Title}: Shifting Views on Cancer Pain Management: A Systematic Review and Network Meta-Analysis.
{Author}: Imkamp MSV;Theunissen M;Viechtbauer W;van Kuijk SMJ;van den Beuken-van Everdingen MHJ;
{Journal}: J Pain Symptom Manage
{Volume}: 68
{Issue}: 3
{Year}: 2024 Sep 4
{Factor}: 5.576
{DOI}: 10.1016/j.jpainsymman.2024.05.022
{Abstract}: <B>BACKGROUND: </B>Strong opioids are the cornerstone in the treatment of cancer-related pain.<BR><B>OBJECTIVE: </B>This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain.<BR><B>METHODS: </B>PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks.<BR><B>RESULTS: </B>Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP.<BR><B>CONCLUSIONS: </B>The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain.