***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background While opioids provide effective analgesia , opioid-induced constipation ( OIC ) can severely impact quality of life and treatment compliance . This pooled analysis evaluated the maintenance of efficacy and safety during long-term treatment with combined oxycodone/naloxone prolonged-release tablets ( OXN PR ) in adults with moderate-to-severe chronic pain . Methods Patients ( N = 474 ) received open-label OXN PR during 52-week extension phases of two studies , having completed 12-week , double-blind , r and omized treatment with oxycodone prolonged-release tablets ( Oxy PR ) or OXN PR . Analgesia and bowel function were assessed at each study visit using ‘ Average pain over last 24 h scale and Bowel Function Index ( BFI ) , respectively . Treatment Satisfaction Question naire for Medication was assessed at study end only . Key Results Improvement in bowel function was particularly marked in patients who switched from Oxy PR in the double-blind phase to OXN PR during the extension phase , result ing in a clinical ly meaningful reduction ( ≥12 points ) in BFI score : at the start of the extension phases , mean ( SD ) BFI score was 44.3 ( 28.13 ) , and was 29.8 ( 26.36 ) for patients who had received OXN PR in the double-blind phase . One week later , BFI scores were similar for the two groups ( 26.5 [ 24.40 ] and 27.5 [ 25.60 ] , respectively ) , as was observed throughout the following months . Fewer than 10 % of patients received laxatives regularly . Mean 24-h pain scores were low and stable throughout the extension phases . No unexpected adverse events were observed . Conclusions & Inferences Pooled data demonstrate OXN PR is an effective long-term therapy for patients with chronic non-cancer pain , and can address symptoms of OIC . No new safety issues were observed which were attributable to the long-term administration of OXN PR This study compared the efficacy of a tetrahydrocannabinol : cannabidiol ( THC : CBD ) extract , a nonopioid analgesic endocannabinoid system modulator , and a THC extract , with placebo , in relieving pain in patients with advanced cancer . In total , 177 patients with cancer pain , who experienced inadequate analgesia despite chronic opioid dosing , entered a two-week , multicenter , double-blind , r and omized , placebo-controlled , parallel-group trial . Patients were r and omized to THC : CBD extract ( n = 60 ) , THC extract ( n = 58 ) , or placebo ( n = 59 ) . The primary analysis of change from baseline in mean pain Numerical Rating Scale ( NRS ) score was statistically significantly in favor of THC : CBD compared with placebo ( improvement of -1.37 vs. -0.69 ) , whereas the THC group showed a nonsignificant change ( -1.01 vs. -0.69 ) . Twice as many patients taking THC : CBD showed a reduction of more than 30 % from baseline pain NRS score when compared with placebo ( 23 [ 43 % ] vs. 12 [ 21 % ] ) . The associated odds ratio was statistically significant , whereas the number of THC group responders was similar to placebo ( 12 [ 23 % ] vs. 12 [ 21 % ] ) and did not reach statistical significance . There was no change from baseline in median dose of opioid background medication or mean number of doses of breakthrough medication across treatment groups . No significant group differences were found in the NRS sleep quality or nausea scores or the pain control assessment . However , the results from the European Organisation for Research and Treatment of Cancer Quality of Life Cancer Question naire showed a worsening in nausea and vomiting with THC : CBD compared with placebo ( P = 0.02 ) , whereas THC had no difference ( P = 1.0 ) . Most drug-related adverse events were mild/moderate in severity . This study shows that THC : CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids Neuropathic cancer pain represents a major challenge . Treatment often requires adjuvant analgesics , including gabapentin , to complement the effects of opioids . This study aim ed to compare the effectiveness and safety of gabapentin combined with an opioid versus opioid monotherapy for the management of neuropathic cancer pain . Seventy-five cancer patients who were receiving opioid therapy and reported sufficient pain relief of nociceptive , but not neuropathic , pain were enrolled . Sixty-three patients completed the study . Patients were r and omized to one of the following treatment protocol s : 1 ) gabapentin adjuvant to ongoing opioid treatment titrated according to pain response while opioid dose was kept constant ( group GO ) , and 2 ) continuation of opioid monotherapy according to the World Health Organization treatment ladder approach ( group OO ) . Changes in pain intensity , allodynia , and analgesic drug consumption were evaluated at Day 4 and Day 13 . Side effects were also recorded . Both treatments result ed in a significant reduction of pain intensity at Day 4 and Day 13 compared to baseline . However , mean pain intensity for burning and shooting pain was significantly higher in the OO group compared to the GO group at both the fourth ( P=0.0001 ) and 13th ( P=0.0001 ) days of the study . An earlier significant decrease ( at Day 4 , P=0.002 ) was observed for allodynia in the GO group compared to the OO group . The rate of side effects in the GO group was significantly lower than that in the OO group ( P=0.015 ) . These data suggest that gabapentin added to an opioid provides better relief of neuropathic pain in cancer patients than opioid monotherapy ; this combination of gabapentin and an opioid may represent a potential first-line regimen for the management of pain in these patients Strong opioids are recommended for treating severe cancer pain in the advanced stages of the disease . Few data are available concerning the efficacy of buprenorphine in cancer pain . We compared transdermal buprenorphine 70 microg/h ( BUP TDS ) to placebo in an enriched design study . Opioid-tolerant patients with cancer pain requiring strong opioids in the dose range of 90 - 150 mg/d oral morphine equivalents entered a two-week run-in phase , during which they were converted to BUP TDS .  Patients who could be stabilized on BUP TDS were r and omized to BUP TDS or placebo patch for a two-week maintenance phase . Rescue medication ( buprenorphine sublingual tablets 0.2 mg ) was allowed as required . Response was defined as a mean pain intensity of < 5 ( 0 - 10 scale ) and a mean daily buprenorphine sublingual tablet intake of < or = 2 tablets during the maintenance phase . Of 289 patients who entered the run-in phase , 100 discontinued treatment due to lack of efficacy or adverse events ; 189 patients continued treatment in the maintenance phase ( 94 BUP TDS , 95 placebo ) , of whom 31 discontinued treatment ( 7 BUP TDS , 24 placebo ) . A significant difference in the number of treatment responders was observed : 70 BUP TDS ( 74.5 % , 65.7 - 83.3 ) vs. 47 placebo ( 50 % , 39.9 - 60.1 ) ( P=0.0003 ) . This result was supported by a lower daily pain intensity , lower intake of buprenorphine sublingual tablets and fewer dropouts in the BUP TDS group . The incidence of adverse events was slightly higher for BUP TDS . In conclusion , BUP TDS 70 microg/h is an efficacious and safe treatment for patients with severe cancer pain Objectives This study aims to evaluate the efficacy of methadone as substitute for morphine and to investigate if the addition of acetaminophen could reduce the time to attain an equianalgesic dose of methadone and /or to improve the level of pain control in oncologic patients . Patients and methods Fifty patients on stable doses of morphine for 1 week were switched to methadone using a “ stop – start ” strategy and r and omized in a double-blind fashion to receive either acetaminophen ( 750 mg PO every 6 hours ) or placebo for a 7-day period . We collected data regarding level of pain , side effects , and quality of life . Results Substitution of morphine for methadone result ed in a significant reduction in constipation ( p < 0.001 ) and xerostomia ( p = 0.03 ) . There was also an improvement in the numeric pain scale ( p = 0.03 ) as well as a significant improvement in the functional level and symptomatology according to the QLQ-C30 question naire . Addition of acetaminophen did not improve pain control or reduce the time of stabilization of analgesia once methadone was introduced . At the end of the study , most patients ( 70.8 % , p = 0.001 ) preferred methadone to morphine . Conclusions Early switching from morphine to methadone was a safe and efficient strategy for the reduction of side effects and improvement of analgesia , allowing for a comfortable dosing regimen . In this scenario , the association with acetaminophen did not improve pain control or reduce the time to achieve an equianalgesic dose of methadone In addition to modern medicinal therapy , many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet . In this paper , the effect of a Taiwanese traditional herbal diet ( TTHD ) on pain  in terminal cancer patients was investigated . A total of 2,466 patients diagnosed with a variety of cancers were included . The most common patient-reported symptoms included troublesome pain ( 79.2 % ) , weakness ( 69.0 % ) , anorexia ( 46.4 % ) , fever ( 36.5 % ) , dyspnea ( 31.1 % ) , and leg edema ( 30.9 % ) . The 2,466 terminal cancer patients included in the study were r and omly divided into three groups . The TTHD group ( n=1044 ; 42.3 % ) were given the TTHD consisting of analgesic herbs ( paeony root : licorice root=1:1 ) and a Taiwanese tonic vegetable soup ( Lilii bulbus , Nelumbo seed , and Jujube fruit ) . The remaining patients were divided into a reference group , given the regular hospital diet , ( n=909 , 36.9 % ) and a control group , given the Taiwanese tonic vegetable soup without analgesic herbs , ( n=513 , 20.8 % ) . All patients maintained their assigned diets for one week . A verbal numerical scale was used to assess pain . Results revealed that the patients given TTHD reported enhanced pain relief ( p<0.05 ) compared to the reference and control groups . We found that TTHD could alleviate the pain among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient 's quality of life . Further research is warranted OBJECTIVE We prospect ively investigated the efficacy of opioid rotation from oral morphine to oral oxycodone in cancer patients who had difficulty in continuing oral morphine treatment because of inadequate analgesia and /or intolerable side effects . METHODS Twenty-seven patients were enrolled and 25 were evaluated . The rate of patients who achieved adequate pain control , which provided an indication of treatment success , was evaluated as primary endpoint . The acceptability and pharmacokinetics of oxycodone were evaluated in addition to the assessment of analgesic efficacy and safety during the study period . RESULTS In spite of intense pain , the morphine daily dose could not be increased in most patients before the study because of intolerable side effects . However , switching to oral oxycodone allowed approximately 1.7-fold increase as morphine equivalent dose . Consequently , 84.0 % ( 21/25 ) of patients achieved adequate pain control . By the end of the study , all patients except one had tolerated the morphine-induced intolerable side effects ( i.e. nausea , vomiting , constipation , drowsiness ) . Common side effects ( > 10 % ) that occurred during the study were typically known for strong opioid analgesics , and most were mild to moderate in severity . A significant negative correlation between creatinine clearance ( CCr ) value and the trough concentrations of the morphine metabolites was observed . On the other h and , no significant correlation was found between CCr value and the pharmacokinetic parameters of oxycodone or its metabolites . CONCLUSIONS For patients who had difficulty in continuing oral morphine treatment , regardless of renal function , opioid rotation to oral oxycodone may be an effective approach to alleviate intolerable side effects and pain BACKGROUND AND OBJECTIVES Visceral pain is a significant issue for patients , and the importance of treating pain is underestimated . New opioid formulations , the primary treatment option for moderate-to-severe pain , have been shown to be effective , but no studies have been conducted to address the efficacy of these agents for visceral pain . This study was conducted to determine the incidence of visceral pain in patients with uncontrolled moderate-to-severe pain , and to evaluate the efficacy of controlled-release ( CR ) oxycodone in this context . MATERIAL S AND METHODS s : In this multicenter , prospect i ve , observational study , 967 of 980 evaluated patients were included , 350 ( 36.2 % ) of whom presented mainly visceral pain . In most cases ( 57.0 % ) , patients had experienced pain for < or = 3 months , and the majority ( 94.9 % ) were cancer patients . 
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FINDINGS : Opioids are the mainstay of cancer pain management , but evidence supports the use of coanalgesics and adjuvants to improve overall pain management .