SHEFFIELD, UK-What should the research question be when investigating a new approach to cancer pain? The most obvious answer is, Does it relieve pain? But David Brooks, MB, of the University of Sheffield, argues that this is not enough. Researchers must also ask about side effects, quality of life, and patient preference.
Speaking at a symposium held in association with the 8th World Congress on Pain, Dr. Brooks described a multicenter, open, randomized, crossover trial comparing transdermal fentanyl(Drug information on fentanyl) (Duragesic) with sustained-release oral morphine(Drug information on morphine). The subjects were 202 patients with cancer pain who were previously receiving stable doses of oral morphine.
No significant difference in pain relief was seen between the two drugs among the 110 patients who completed the trial. "This was no surprise since the trial was designed so that only patients who had stable opioid responsive pain were included," Dr. Brooks said. "So for this kind of trial, pain assessment alone is inadequate as a single outcome measure."
However, in this study, researchers also included questions about patient preference; 90% of the study subjects did, in fact, have a preference, with 36% preferring morphine and 54% fentanyl. "Patient preference gives an overall assessment of the therapy from the patient's point of view," he said. "It gets patients to weigh various effects individually."
As an example, he said, for one patient a bad-tasting medication means the whole day is taken up with anticipatory nausea thinking about it, whereas another patient may simply take the bad taste in stride.
The point, Dr. Brook believes, is that physicians must individualize pain treatment. "No one therapy is likely to be universally superior on every symptom subscale," he said.
In the fentanyl study, for some quality of life issues, fentanyl was generally preferable to morphine; it caused less interruption of daily activities and was more convenient to take. But interestingly, for no single quality of life item was fentanyl or morphine universally preferred.