Most patients with CNCP are treated with long-acting (controlled-release) opioids rather than short-acting preparations, in the belief that steady plasma levels are associated with better pain control and fewer adverse effects, including withdrawal or dependency. Indeed, most consensus guidelines recommend the use of long-acting opioids for the treatment of CNCP.9, 11
However, the systematic review by Chou et al.20[I] (568 patients in seven RCTs) found there was insufficient evidence to determine if either long- or short-acting opioids were superior in the treatment of CNCP. Again there were problems with heterogeneity and the quality of the trials. However, in a subanalysis of three RCTs, there was fair evidence that short- and long-acting preparations of oxycodone were equally effective. In addition, two RCTs found that the total daily opioid dose was lower using short-acting morphine or codeine compared with long-acting forms.
In conclusion, there are insufficient data to determine if there is a difference between short- and long-acting opioids in the treatment of CNCP, in terms of efficacy or safety. However, subanalysis of the data suggests that short-acting opioids may be just as effective as long-acting preparations and result in reduced daily opioid doses.
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