***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although the oral route is the preferred method of opioid therapy in patients with cancer pain , many patients will require an alternate route of analgesic administration at some point during the trajectory of their illness . This study compared the efficacy and safety of a novel , controlled-release suppository of morphine ( MSC-R ) and controlled-release morphine tablets ( MSC-T ) in patients with cancer pain . In a double-blind crossover study , 27 patients with cancer pain were r and omized to receive MSC-R or MSC-T every 12 hours for 7 days each , using a 1:1 analgesic equivalence ratio . Pain intensity was assessed using a visual analog scale ( VAS ) and the Present Pain Intensity Index of the McGill Pain Question naire . Nausea and sedation were also assessed with a VAS . Pharmacodynamic assessment s were made by the patient at 8:00 AM , 12:00 PM , 4:00 PM , and 8:00 PM and rescue morphine use recorded in a daily diary . There were no significant differences between MSC-R and MSC-T in overall scores for pain intensity VAS , ordinal pain intensity , and sedation . There was a small but significant difference in overall nausea VAS score in favor of MSC-R.  Mean daily rescue analgesic use did not differ significantly during between treatment with MSC-R and MSC-T. MSC-R provides pain control comparable to that provided by MSC-T when given every 12 hours at a 1:1 dose ratio , and represents a reliable alternative method of pain control for patients unable to take oral opioid agents Aim of the study To compare analgesia and adverse effects during oral morphine and oxycodone and transdermal fentanyl and buprenorphine administration in cancer patients with pain . Patients and methods Cancer patients treated at home and in outpatient clinics with severe pain ( numerical rating scale score 6–10 ) fail to respond to non-opioids and /or weak opioids . All patients were r and omized to either morphine , oxycodone , fentanyl or buprenorphine and divided into subgroups with predominant neuropathic and nociceptive pain component . Doses of opioids were titrated to satisfactory analgesia and acceptable adverse effects intensity . Patients were assessed at baseline and followed for 28 days . In all patient groups , immediate-release oral morphine was the rescue analgesic and lactulose 10 mL twice daily was the prophylaxis of constipation ; no antiemetics were used as prophylaxis . Results A total of 62 patients participated and 53 patients completed the study .  Good analgesia was obtained for all 4 opioids , for both nociceptive and neuropathic pain . The use of co-analgesics was greater in patients with neuropathic pain . Morphine treatment was associated with less negative impact of pain on ability to walk , work and activity ( trend ) according to Brief Pain Inventory-Short Form scores and less consumption of rescue morphine . The most common adverse effects included nausea and drowsiness , which increased at the beginning of the treatment and gradually decreased over the days to come . Appetite , well-being , anxiety , depression , and fatigue improved . There was no constipation ( the Bowel Function Index scores were within normal range ) during the treatment with all opioids . No changes were seen for constipation , vomiting and dyspnea . Conclusion All opioids were effective and well-tolerated . Morphine was the most effective in the improvement in some of the Brief Pain Inventory-Short Form items regarding negative impact of pain on patients ’ daily activities . Prophylaxis of constipation was effective ; antiemetics may be considered for nausea prevention AIM Opioid switching is a treatment strategy in cancer patients with unacceptable pain and /or adverse effects ( AEs ) . We investigated whether patients switched to methadone by the stop and go ( SAG ) strategy have lower pain intensity ( PI ) than the patients switched over three days ( 3DS ) , and whether the SAG strategy is as safe as the 3DS strategy . METHODS In this prospect i ve , open , parallel-group , multicentre study , 42 cancer patients on morphine or oxycodone were r and omised to the SAG or 3DS switching- strategy to methadone . The methadone dose was calculated using a dose-dependent ratio . PI , AEs and serious adverse events ( SAEs ) were recorded daily for 14 days . Primary outcome was average PI day 3 . Secondary outcomes were PI now and AEs day 3 and 14 and number of SAEs . RESULTS Twenty one patients were r and omised to each group , 16 ( SAG ) and 19 ( 3DS ) patients received methadone . The mean preswitch morphine doses were 900 mg/day in SAG and 1330 mg/day in 3DS . No differences between groups were found in mean average PI day 3 ( mean difference 0.5 ( CI -1.2 - 2.2 ) ; SAG 4.1 ( CI 2.3 - 5.9 ) and 3DS 3.6 ( CI 2.9 - 4.3 ) or in PI now . The SAG group had more dropouts and three SAEs ( two deaths and one severe sedation ) . No SAEs were observed in the 3DS group . CONCLUSION The SAG patients reported a trend of more pain , had significantly more dropouts and three SAEs , which indicate that the SAG strategy should not replace the 3DS when switching from high doses of morphine or oxycodone to methadone Context Symptom control research in patients with advanced cancer is not common . This may be the result of a belief that this research is unethical , not practical , or that patients are not interested . However , the experiences of cancer patients who have actually taken part in symptom control research near the end of life have never been detailed . Objectives The objective was to explore the experiences of patients with advanced cancer who had taken part in symptom control trials . Methods A prospect i ve two-center study was undertaken using grounded theory methodology . Theoretical sampling was used to recruit patients from one of two double-blind , r and omized , placebo-controlled trials study ing novel analgesic agents for cancer-related pain . Participants completed one semistructured interview . Recruitment and interviewing continued until data saturation was achieved . Results Twenty-one participants were recruited . Fifteen ( 71 % ) were male , with a mean age of 62 years . Key themes identified included reasons for trial participation , participants ' interactions with the trial staff , and participants ' responses to the effect the trial had on their pain . In general , participants regarded taking part in a clinical trial as a positive experience , and potentially improving overall well-being . Crucially , this was not related to whether there had been an improvement in symptoms . Conclusion The findings provide grounds for optimism that patients with advanced cancer may benefit from taking part in symptom control trials , supporting the paradigm that participation in symptom control research should be encouraged in this population A single institution , prospect i ve , r and omized trial was performed in terminal cancer patients to compare tropisetron ( TRO ) , metoclopramide ( MET ) , and chlorpromazine ( CHL ) in the management of nausea and emesis .  Patients had far advanced cancer , were far removed from chemotherapy or radiotherapy  , and their nausea and emesis was not due to bowel obstruction , drug intake , or cranial , electrolytic , or metabolic causes . The effects of antiemetic treatments were evaluated from Days 1‐15 Nausea affects from 40 % to 70 % of cancer patients who received narcotics to manage their pain . This occurs more frequently when they are ambulatory than when they are recumbent and may be the result of narcotic-enhanced labyrinthine sensitivity to motion . Scopolamine has previously been found to be an effective antiemetic for motion sickness . In a prospect i ve pilot study , 9 ( 69 % ) of 13 cancer patients experienced rapid relief of their narcotic-induced nausea when they used Scopolamine Transderm-V patches alone . Only two patients experienced side effects with the scopolamine , and in one patient , the side effects may have been dose related . Although tolerance to the increased vestibular sensitivity may occur , this was not universal . Further prospect i ve trials are necessary to establish whether transdermal scopolamine is useful in controlling the narcotic-induced nausea experienced by cancer patients Little information is available about the incidence , prevalence , or severity of morphine side effects during repeated individualized dosing for chronic cancer pain , although it has been widely used in this way for more than 30 years . The authors ’ aim was to describe the prevalence of symptoms possibly attributable to morphine side effects in a convenience sample of patients with pain due to advanced cancer . They used a prospect i ve survey of in patients and out patients on regularly dosed morphine  , with a question naire administered weekly for 4 weeks . Forty-two of 56 eligible patients completed at least the first question naire , with 30 completing all 4 . Dry mouth was the most common symptom reported ( point prevalence , 95 % ) ; this was often moderate to severe in intensity ( 57 % ) and was the most persistent symptom ( period prevalence , 20 % ) . Sedation and constipation were frequent ( point prevalence , 88 % ) and was often moderate or severe at some point ( 55 % and 62 % , respectively ) but had low period prevalence . Nausea was reported by less than half the patients . Myoclonus was common ( point prevalence , 83 % ) but was usually mild and not persistent . Total daily morphine dose had little impact on side-effect patterns . Constipation , dysphoria , myoclonus , nausea , and sedation were more likely to be severe following dose increases . In conclusion , although constipation , nausea , and sedation are well described as side effects of morphine administration , others such as dry mouth and myoclonus appear to be underestimated . Vali date d patient-based measures of opioid side effects are needed In a double‐blind crossover study , morphine and oxycodone hydrochloride were administered to 20 patients who were experiencing severe cancer pain . The peroral doses were determined on the basis of patient‐controlled intravenous titration . The assumed oral bioavailability ratios were 44 % ( group 1 , first 10 patients ) and 33 % ( group 2 , last 10 patients ) for morphine and 66 % ( group 1 ) and 50 % ( group 2 ) for oxycodone hydrochloride , respectively . However , the patients were able to readjust their oral dosings . Equal analgesia was achieved with both drugs , but the intravenous dose of oxycodone hydrochloride needed was 30 % higher than that of morphine .  The median calculated oral/intravenous ratios giving comparable analgesia were 0.31 for morphine and 0.70 for oxycodone hydrochloride . Morphine caused more nausea than oxycodone hydrochloride and hallucinations occurred only during morphine treatment . Otherwise , there were no major differences in the side effects between these two opioids The transdermal therapeutic system ( TTS ) for fentanyl is a drug-delivery system for use in patients with chronic pain who require an opioid analgesic . A multicentre , r and omized , double-blind , placebo-controlled study was performed to evaluate the efficacy and safety of TTS-fentanyl as an analgesic for chronic cancer pain . One hundred and thirty-eight patients entered a 15-day dose-titration period , followed by a 9-day double-blind period ( 95 patients ) with TTS-fentanyl or placebo .  Fifty-five patients entered a follow-up period of indefinite duration . For the majority of patients , TTS-fentanyl 50 - 75 µg/h provided effective analgesia . Due to an unexpectedly high placebo response , it was not possible to show fentanyl to be statistically superior to placebo at the 5 % significance level . Nine patients treated with fentanyl and 13 treated with placebo were withdrawn from the study during the double-blind therapy because of insufficient efficacy ( not significant ) , while 66 % of fentanyl-treated patients experienced effective pain control compared with 48 % of placebo-treated patients ( p=0.071 ) . During the course of the double-blind therapy , the mean dose of rescue morphine increased slightly more in the placebo group than in the fentanyl group . At the end of the double-blind phase , the investigators rated trial medication as being ' good ' or ' excellent ' in 30 patients in the fentanyl group and 23 in the placebo group .  TTS-fentanyl  appeared to be well tolerated , with a low incidence of constipation , somnolence and nausea . Due to an unexpectedly high placebo response it was not possible to demonstrate fentanyl to be statistically superior to placebo . This may reflect the practical difficulties of performing clinical trials in cancer patients with great inter-individual variability . Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain INTRODUCTION The purpose of this trial was to evaluate the effect of long-term treatment with oral sustained-release hydromorphone , transdermal fentanyl , and transdermal buprenorphine on nausea , emesis and constipation . PATIENTS AND METHODS R and omly selected out patients with cancer pain receiving one of the study medications were enrolled in a prospect i ve , open-labeled , controlled trial ( n=174 ) .  Mobility , pain , and gastrointestinal symptoms were assessed directly and per selected item on the ECOG ( Eastern Cancer Oncology Group ) , EORTC ( European Organisation for Research and Treatment of Cancer ) question naires , NRS ( Numerical Rating Scales ) , and analyzed statistically . RESULTS Demographic and medical data were comparable in all groups . Only 15 % of patients suffered from constipation . 59 % took the prescribed lax 
    Output:
    
This systematic review can make only weak recommendations for the management of opioid-induced nausea and vomiting .