This Rapid Review from the NPC appraises a 4 week clinical trial of prolonged release (PR) oxycodone/naloxone compared with PR oxycodone alone in patients with moderate to severe cancer pain, which found some limited benefit in constipation symptoms the combination product. There was no difference in pain relief between the two groups and it is not known whether PR oxycodone/naloxone offers any advantage to the use of PR oxycodone, or other strong opioids (e.g. modified-release morphine), when given with prophylactic laxatives.

The review advises healthcare professionals to continue to manage pain in patients with cancer according to WHO’s pain relief ladder, where strong opioids are recommended for relief of moderate to severe pain. It notes that the SIGN guideline for control of pain in adults with cancer recommends that morphine should be used first-line for oral use in severe cancer pain; although oxycodone can be considered as an alternative. In addition, there is a lack of evidence from high quality comparative trials that other opioids have advantages over morphine in terms of either efficacy or side effects. Furthermore there is uncertainty about the best management of constipation in these patients who are prescribed opioids for moderate to severe pain, though the SIGN guideline suggests that the best prophylactic treatment is a combination of stimulant and softening laxatives- a recommendation that is not changed by the current study.

NICE is currently developing a guideline on the use of opioids in palliative care, which is due for publication in May 2012.