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- Title
Oral oxycodone/naloxone for pain control in cirrhosis: Observational study in patients with symptomatic metastatic hepatocellular carcinoma.
- Authors
Tovoli, Francesco; Piscaglia, Fabio; Benevento, Francesca; Bolondi, Luigi; De Lorenzo, Stefania; Brandi, Giovanni; Samolsky Dekel, Boaz G.
- Abstract
Abstract: Background & Aims: Pain management in cirrhosis is a clinical challenge. Most analgesics are metabolized in the liver and cirrhosis may deeply alter their concentration, favouring the appearance of side effects. We aimed to assess the efficacy and safety of oral prolonged‐release association of oxycodone/naloxone tablets (OXN) in the treatment of moderate/severe cancer pain in cirrhotic patients with metastatic hepatocellular carcinoma (HCC). Methods: We enrolled n = 32 HCC patients with moderate/severe cancer pain unresponsive to paracetamol alone or associated with codeine or tramadol. All patients received an initial OXN dose of 5 mg bid to be gradually increased in case of insufficient analgesia. At baseline and follow‐up visits, we evaluated: pain intensity (using the Numerical Rating Scale, NRS), patients’ autonomy in daily activities (Barthel Functioning Index); bowel dysfunction (Bowel Function Index, BFI), signs of hepatic encephalopathy (HE) and other opioid‐induced side effects. Results: No clinically significant adverse effects were reported (median follow‐up 122 days). No significant worsening of the BFI score was noted and no cases of HE were detected. Two patients (6.3%) discontinued treatment before T14 because of mild nausea and dizziness. The remaining n = 30 patients were assessed for efficacy. Treatment led to a significant reduction in the mean of pain scores both at T14 (−37.1 ± 16.3%, <italic>P</italic> < .001) and at T28 (−55.6 ± 21.5%, <italic>P</italic> < .001); Barthel scores showed gradual and significant increase from T0 (81.6 ± 13.0) to T14 (86.5 ± 11.4, <italic>P</italic> = .001) and to T28 (88.3 ± 13.6, <italic>P</italic> = .009). Conclusions: OXN may be considered a safe and effective option in the fragile population of cirrhotic patients.
- Subjects
TREATMENT of cirrhosis of the liver; PAIN management; OXYCODONE; NALOXONE; LIVER cancer patients; ORAL drug administration
- Publication
Liver International, 2018, Vol 38, Issue 2, p278
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.13546