Comparison of the analgesic effects of the morphine and oxycodone

Background

Morphine and oxycodone are both an opioid that is widely used to treat moderate/severe cancer pain. However, there is debate over the research evidence on their relative tolerance and their underlying outcomes.

Methods

A systematic search of the online electronic databases, Buy Oxycodone online  such as PubMed, Embase, and Cochrane Library, updated in October 2017 was carried out. A meta-analysis was conducted with the study designs as controlled, randomized studies.

Eligibility requirements

Studies that are included in the meta-analysis must satisfy the following criteria: (1) the studies are designed as controlled randomized studies; (2) the primary objective was to evaluate the patients suffering from cancer-related pain that were clinically responsive to morphine and Oxycodone as a first-line treatment. (3) studies that provide evidence of analgesic effects for both two groups, as well as the Hazard Ratio (HR) and 95% CIs reported when we discovered multiple data that overlapped or duplicated in multiple studies We will include the report that has the most complete data.

The study excluded our current analysis (1) randomised controlled trials; (2) data on the main outcomes were not available; (3) Studies including patients who received the oxycodone or morphine, in combination with other cancer drugs to treat pain.

Assessment of quality

Two independent researchers rated their respective study’s quality. studies. The study’s quality was evaluated with the Newcastle-Ottawa Quality Scale.

Data extraction

The two authors were able to independently extract relevant information from each study. There was a consensus to resolve disagreements. In each of the eligible studies, the primary classifications are based on the following criteria: the first author’s name the name of the family member and publication year the study’s duration, the country the number of patients studies interventions, analgesic impact factors (Pain Relief Rate and Average Pain Inventory as well as the Worst Pain Index) and other adverse response parameters (nausea and vomiting, tiredness constipation, diarrhea, and nausea). ).

Analytical analysis of statistics

A sensitivity study was carried out to assess the impact on the overall result in relation to the degree of heterogeneity among the studies. Heterogeneity was measured by calculating an I2 statistic [27The I2 statistic was calculated [27. Heterogeneity that had I2 values of I2 of 25-50 percent, 50-75%, or greater than 75% indicates moderate, low or high heterogeneity according to [2828. In the case of low heterogeneity in studies, data were analysed using a fixed effects model. In other cases Random effects models were employed. If a P-value was 0.05 was considered to be statistically significant. The statistical analysis was conducted with Review Manager version 5.3 software (Revman and the Cochrane Collaboration Oxford, United Kingdom). Our meta-analysis results were presented in plots of forest. The Begg test as well as Egger test were used to evaluate publication bias. Egger test were used to test for bias in publication.

Results

Overview of the literature search and study specifics

The total of 434 research studies were initially retrieved for analysis. In accordance with the guidelines set forth in the methodology twelve studies were analyzed more in depth, but some required additional information about the outcomes from both methods. So, a total of seven RCTs was included in the meta-analysis. The process of searching is explained in Fig.

Background

The principal for treating cancer pain, called the three-step analgesic ladder was created in WHO in 1986. World Health Organization (WHO) in 1986. The 3-step ladder therapy recommends the use of non-opioid analgesics in cases of weak opioids and powerful opioids to treat moderate-severe pain. Indeed, these medications have been used to guide to the best treatment of cancer pain.

There is an increase in cancer patients receiving adequate analgesia through opioid treatment [22. Opioids are used to treat moderate to severe pain, if properly prescribed [3, 43. Oral morphine is traditionally extensively used to treat patients suffering from moderate or severe pain, according to WHO ladder step-III. The lower fluctuations in plasma drug concentrations are expected to result in acceptable adverse effects, and possibly more efficacy when taking short-acting opioids.

However, other powerful opioids like oxycodone are also available as alternatives. According to European Association for Palliative Care guidelines, oxycodone was a viable alternative treatment for cancer patients for morphine in 2001. It is also advised for use in clinical trials. Oxycodone (OX) is known to have demonstrated an identical profile and has been proven to decrease pain statistically, mostly in the central nervous system.

Recent guidelines have suggested the use of oxycodone and morphine as primary opioids to treat pain from cancer however the evidence for their use is not conclusive. A number of studies have examined the analgesic effectiveness and negative effects of various opioids in patients with cancer. An identical analgesic efficacy as well as safety profile was found throughout the treatment, despite there were differences in the method of assessment and design. There were no significant differences in two RCTs that were open-label and that compared the first-line treatment of oxycodone and morphine.

In fact, patients suffering from cancer who suffer from depression and anxiety show an improvement in the sympsymptoms of pain. This suggests an inadvertent usage of opioids to alleviate “pain experience” and suffering.. Opioid addiction and abuse are often are the most frequent complaints of cancer pain sufferers who are receiving opioid analgesia. Additionally, the successful treatment of pain from cancer is based on getting an adequate level of relief for symptoms while minimizing negative events (AEs) within a way that is comfortable for patients. Furthermore, the majority of RCTs that compare different opioids do not have a solid evidence-based basis for terms of definitions, measurements and the reporting on adverse reactions (AEs ).

In this regard the study was launched to determine the efficacy and the safety of comparing morphine and Oxcodone for patients suffering from cancer pain.

Search strategy

Two researchers independently searched the electronic databases, including Pubmed, Embase, and Cochrane library from October of 2017. The procedure was designed to search for all articles that had keywords such as “oxycodone,” “morphine,” and “cancer pain,” Buy Oxycodone and pertinent medical Subject Heading (MeSH) terms were searched for. The list of references for all articles on the subject relevant to the issue were searched to look for any other relevant articles.

Medical Subject Heading (MeSH) terms refer to the following: oxycodone, morphine as well as pain.