Tessaro, L., Bandieri, E., Costa, G., Fornasier, G., Iorno, V., Pizza, C., . . . Micheletto, G. (2010). Use of oxycodone controlled-release immediately after NSAIDs: A new approach to obtain good pain control. European Review for Medical and Pharmacological Sciences, 14(2), 113–121.

To evaluate the efficacy and tolerability of controlled-release (CR) oxycodone as first-line therapy in patients with chronic pain not relieved by nonsteroidal anti-inflammatory drugs (NSAIDs).

Patients with NSAID-refractory chronic pain 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. Primary end point was reduction in numeric rating scale (NRS) for pain. Secondary end points were tolerability, quality of life, and patient assessment of treatment efficiency.

• The sample was composed of 309 patients.
• Mean patient age was 67.1 years. Age range was 31–94 years.
• Of all patients, 50% were female and 50% were male.
• All patients had moderate to severe cancer or noncancer pain (that is, pain rated 4–10 on the 0–10 NRS). Of all patients, 24.3% had somatic pain, 14.1% had neuropathic pain, 8.2% had visceral pain, and 53.4% had mixed pain. Patients had had no previous or ongoing treatment with opioids.

Multisite

Prospective

• Numeric Rating Scale (NRS)
• Brief Pain Inventory (BPI)

Data revealed a significant decrease (57%) in pain intensity during the first week of therapy: a  decrease in NRS pain score from 7.85 + 1.4 to 3.35 + 1.8 (p < 0.00001). Overall, by the end of the study, NRS pain score had decreased 72.3% from baseline. Quality of life improved significantly (p < 0.005) during oxycodone therapy, and 91% of patients rated the treatment as effective or very effective.

Historically, according to guidelines of the World Health Organization, oxycodone CR has been reserved for step 3 of treatment. This study examines earlier use of oxycodone CR in the management of chronic cancer and noncancer pain, as a first-line treatment after NSAIDs. The results of this study warrant consideration because earlier, more effective pain control enhances quality of life.

The study has a risk of bias due to no appropriate control group.

Pain management must be individualized. Controlled-release opioids may be useful as an intervention after NSAIDs. However, randomized control-group research comparing the results of studies that use CR opioids in step 2 would be of value.