Until now, opioids have not been considered to be very effective for neuropathic (nerve) pain. They have been a second- or third-line treatment option at best. However, a new study has shown that in many cases opioids can be effective in relieving neuropathic pain.
A research report presented at the American Academy of Pain Medicine's annual meeting indicated that patients with neuropathic cancer pain had obtained consistent, long-term pain control with extended-release oxymorphone.
The 27 neuropathic pain patients who participated in the study had completed a short-term trial of oxymorphone prior to beginning this 52-week extension phase. They began the extension phase with the same dosage they had used at the end of the short-term study. Dosage adjustments to improve pain control or tolerability were allowed throughout the extension phase. The median dose of oxymorphone increased from 80 mg at the beginning to 160 mg by the end of the 52 weeks, which was considered to be consistent with the nature of the disease.
The degree of pain relief remained steady throughout the study. On a 100-point pain scale, the pain intensity at the beginning of the study was 32.9 and at the end it was 32.6. This demonstrated that the opioid oxymorphone was able to deliver consistent pain relief for a full year.
Additional evidence of the effectiveness of opioids in treating neuropathic pain can be found in a study I reported on about three months ago: Long-Term Opioid Therapy – What Are the Effects? Although the study grouped some causes of pain together, it seems evident that somewhere between 30 – 50 percent of the participants had some form of neuropathic pain for which opioid therapy was proving to be effective.
Instead of continuing to debate the efficacy of opioids for the treatment of neuropathic pain, I hope the medical community will now turn its attention to identifying which patients can most benefit from their use.
Bankhead C. AAPM: Opioid Gains Long-Term Control of Neuropathic Cancer Pain. MedPage Today. February 2010. http://www.medpagetoday.com/MeetingCoverage/AAPM/18316