Evaluation of pain control in metastatic cancer patients with use of oxycodone: a clinical experience.

Aim: The management of chronic pain in cancer patients is often difficult. Opioids are a cornerstone for pain treatment. The results of our experience with Oxycodone for cancer pain are based on numerical rate scale (NRS) for pain evaluation. Patients and methods: We have retrospectively reviewed data for pain control in 103 patients ( 67 % outpatient / 37 % inpatient) admitted in our Departement from june 2006 to march 2008. Median age was 64 years (range 19 - 94), median Karnofsky Performance Index was 50 (range 30 - 80). Primary tumor site was 15.5 % gastrointestinal, 9,7 % genitourinary, 1.9 % soft tissue, 27.3 % hematologic, 27.3 % lung, 10.7 % breast, 3.0 % malignant melanoma, 0.9 % brain and 3.6 % unknown. 59.2 % of patients have somatic pain (51,5 % bone metastases), 28.2 % visceral pain and 12.6 % mixed pain. 56.3 % of patients had been previously treated with ”weak” opioids , 34.0 % with high potency opioids and 31.0 % initially underwent Oxycodone. Palliative chemotherapy and/or local radiotherapy was administered in 48.5 % patients. Occasional and breakthrough pain was treated with a short-acting morphine formulation. Results: The baseline NRS pain intensity was 8 (range 6 - 10). We administered Oxicodone and we increased dose until we reach a pain control (NRS < or = 4) evaluating daily NRS pain intensity. A pain control was achieved with 45 mg (range 20 - 120) of Oxycodone as median dose and we measured a median final NRS pain intensity of 3 (range 1 - 4). The median time to pain control was 13 days (range 2 - 58), 12 days in opioid- naïve patients and 16 days for those pretreated. Conclusions: Pain control was achieved in all patients. Oxycodone is manageable both in outpatients and in inpatients. NRS was useful to improve pain evaluation and we adopted this scale in routine clinical practice.