1. Addressing sleep problems- The role of long-acting opioids
10 : 40 – 11 : 10
Addressing sleep problems-
The role of long-acting opioids
邵 幼 雲
Yu-Yun Shao
Moderator
趙 大 中
Ta-Chung Chao

2. Addressing Sleep Problems The Role of Long-Acting Opioids
台大醫院 腫瘤醫學部
邵幼雲 助理教授
2017 May 6

3. Prevalence of Cancer Pain
A metaanalysis of 52 articles
33%
59%
patients after curative treatment
patients under anticancer treatment
Ann Oncol (2007); 18:

4. Prevalence of Cancer Pain
A metaanalysis of 52 articles
64%
53%
Advanced or terminal disease
 all disease stages
Ann Oncol (2007); 18:

5. Prevalence of Cancer Pain
A metaanalysis of 52 articles
64%
53%
Advanced or terminal disease
 all disease stages
Ann Oncol 2007; 18:

6. Taiwan National Data 2003 to 2011
1,424,048 cancer patients
Acta Anaesthesiologica Taiwanica 2016; 54: 51-56

7. Pain Decreases Life Quality
1190 patients in 10 Asian countries
Cancer Med 2015; 4:

8. Pain and Sleep Disturbance – A Vicious Cycle
Pain Pract. 2011; 11:282-9

9. How to Manage Pain for Better Sleep
Long-acting
Stable concentration
Increase pain threshold continuously
Good compliance
Short-acting
Rapid onset but short duration
Unstable blood concentration
Frequent trough levels
Suitable for background analgesia to prevent pain occurrence
Suitable for breakthrough pain only

10. The Importance of Stable Opioid Concentration
Drug A
Immediate Release (q4h)
Drug B
Monophasic Extended Release (q24h)
Pain
Time
Increased Pain Intensity
Gupta et al. J Pain Sympt Manage 2007; 34: 40-47

11. Long-Acting Opioids for Cancer Pain Control
USA & Canada
Long-Acting Opioids for Cancer Pain Control
Phase I
Prior Opioid stabilization
Phase II (Titration)
3 to 21 days
Phase III (Maintenance)
14 days
OROS® hydromorphone qd
OROS® hydromorphone qd
Previous opioid Therapy
N=148
N=127
N=85
conversion
Opioid stabilization: ≥ 3 consecutive days dose remained unchanged; < 4 doses of rescue medication
For patients receiving transdermal fentanyl, the initial OROS® hydromorphone dose was 8 mg for each 25 μg/h of fentanyl
Patients with chronic cancer pain receiving at least 45 mg morphine equivalent daily (85% under strong opioids)
Titration with increments of 25 –100% of the current OROS® hydromorphone dose if > 2 doses of rescue medications in 24 hours
J Int Med Res. 2008;36:343–352

12. Average Pain Improved after Conversion
J Int Med Res. 2008;36:343–352

13. Sleep and Life Quality Improved after Conversion
J Int Med Res. 2008;36:343–352

14. Long-Acting Opioids for Pain Control & Sleep Disturbance
Korea
Long-Acting Opioids for Pain Control & Sleep Disturbance
Screening
Efficacy evaluation
14 days
Extension phase
84 days
OROS® hydromorphone qd
OROS® hydromorphone qd
Previous opioid Therapy
N=190
N=120
titration
N=74
conversion
Opioid stabilization: ≥ 3 consecutive days dose remained unchanged; < 4 doses of rescue medication
For patients receiving transdermal fentanyl, the initial OROS® hydromorphone dose was 8 mg for each 25 μg/h of fentanyl
Patients with chronic moderate to severe cancer pain and sleep disturbance and under strong opioids
Cancer Res Treat. 2014;46:

15. Pain and Sleep Improved after Conversion
All p < 0.01
Cancer Res Treat. 2014;46:

16. Sleep Better with Hydromorphone OROS
Cancer Res Treat. 2014;46:

17. Long-Acting Opioids for Noncancer Pain Control
USA & Canada
Long-Acting Opioids for Noncancer Pain Control
Phase I
Prior Opioid stabilization
Phase II (Titration)
3 to 14 days
Phase III (Maintenance)
28 days
OROS® hydromorphone qd
OROS® hydromorphone qd
Previous opioid Therapy
N=208
N=207
N=131
conversion
Opioid stabilization: ≥ 3 consecutive days dose remained unchanged; < 4 doses of rescue medication
For patients receiving transdermal fentanyl, the initial OROS® hydromorphone dose was 8 mg for each 25 μg/h of fentanyl
Patients with moderate to severe chronic low back pain
Titration with increments of 25 –100% of the current OROS® hydromorphone dose if > 3 doses of rescue medications in 24 hours
Current Medical Research and Opinion 2007; 23:

18. Pain Improved after Conversion
Worst pain in 24 hrs
Average pain
Pain right now
Least pain in 24 hrs
Current Medical Research and Opinion 2007; 23:

19. Sleep and Life Quality Improved after Conversion
Current Medical Research and Opinion 2007; 23:

20. Hydromorphone OROS vs. Oxycodone
USA
Hydromorphone OROS once daily R
Titration phase
Maintenance phase
Oxycodone twice daily
14 d
28 d
N = 124
Patients with chronic osteoarthritis and moderate to severe pain under NSAID
Patient 2008; 1:

21. Hydromorphone OROS Offers Better Sleep
Patient 2008; 1:

22. Stop the Vicious Cycle!
Long-acting opioids that provide stable blood concentration
Pain Pract. 2011; 11:282-9

23. Take Home Message
Pain leads to sleep disturbance and decreased life quality
Long-acting opioids provide better pain control and better sleep
Hydromorphone OROS was proven to relieve sleep disturbance caused by pain