{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:25:44Z","timestamp":1792218344858,"version":"4.4.0"},"reference-count":33,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Although oral administration of opioids is generally preferable, a parenteral route may be advisable and mandatory in some clinical circumstances. Parenteral administration of opioids may accelerate the achievement of analgesia. The intravenous route fits the need of rapid achievement of analgesia in patients poorly responsive to other opioids and provides a fast analgesia in patients with breakthrough pain, that has a specific temporal pattern requiring a rapid analgesic effect. When the oral route is unavailable for the presence of nausea, vomiting, or dysphagia. the parenteral route is one of the principal options. Opioids have different pharmacokinetic and pharmacodynamic characteristics and should be chosen according to the individual needs. Thus, the knowledge and experience with these routes of administration are mandatory for anesthesiologists committed to cancer pain management.<\/jats:p>","DOI":"10.3390\/cancers15153778","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T01:09:01Z","timestamp":1690333741000},"page":"3778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Use of Parenteral Opioids in Cancer Pain Management"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-6487","authenticated-orcid":false,"given":"Sebastiano","family":"Mercadante","sequence":"first","affiliation":[{"name":"La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Snijders, R.A.H., Brom, L., Theunissen, M., and van den Beuken-van Everdingen, M.H.J. (2023). Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers, 1.","DOI":"10.3390\/cancers15030591"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1007\/s40265-022-01780-6","article-title":"Cancer Pain Treatment Strategies in Patients with Cancer","volume":"82","author":"Mercadante","year":"2022","journal-title":"Drugs"},{"key":"ref_3","unstructured":"(2018). WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents, World Health Organization."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1200\/JCO.22.02198","article-title":"Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline","volume":"41","author":"Paice","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/S1470-2045(09)70350-X","article-title":"Intravenous morphine for management of cancer pain","volume":"11","author":"Mercadante","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1345\/aph.1D395","article-title":"Continuous subcutaneous infusion of opiates at end-of-life","volume":"38","author":"Anderson","year":"2004","journal-title":"Ann. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1002\/j.1552-4604.1995.tb04106.x","article-title":"Steady-state pharmacokinetic evaluation of a novel, controlled-release morphine suppository and subcutaneous morphine in cancer pain","volume":"35","author":"Bruera","year":"1995","journal-title":"J. Clin. Pharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1177\/104990919901600407","article-title":"Intermittent subcutaneous injections of pain medication: Effectiveness, manageability, and satisfaction","volume":"16","author":"Letizia","year":"1999","journal-title":"Am. J. Hosp. Palliat. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1089\/jpm.2007.0176","article-title":"Double-Blind Crossover Comparison of Continuous and Intermittent Subcutaneous Administration of Opioid for Cancer Pain","volume":"11","author":"Watanabe","year":"2008","journal-title":"J. Palliat. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S0885-3924(86)80045-8","article-title":"Continuous Infusion of Opioid Drugs in the Treatment of Cancer Pain: Guidelines for Use","volume":"1","author":"Portenoy","year":"1986","journal-title":"J. Pain Symptom Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0025-7125(16)30867-7","article-title":"Continuous intravenous infusion of opioid drugs","volume":"71","author":"Portenoy","year":"1987","journal-title":"Med. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1054\/bjoc.2001.1680","article-title":"Expert Working group of the research network of the European Association for Palliative Care. Morphine and alternative opioids in cancer pain: The EAPC recommendations","volume":"84","author":"Hanks","year":"2001","journal-title":"Br. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1002\/cncr.10518","article-title":"A Prospective Study Evaluating the Response of Patients with Unrelieved Cancer Pain to Parenteral Opioids","volume":"94","author":"Enting","year":"2002","journal-title":"Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1089\/jpm.2005.8.743","article-title":"Intravenous versus Subcutaneous Morphine Titration in Patients with Persisting Exacerbation of Cancer Pain","volume":"8","author":"Elsner","year":"2005","journal-title":"J. Palliat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0885-3924(97)00004-3","article-title":"Cancer pain emergencies: A protocol for management","volume":"14","author":"Hagen","year":"1997","journal-title":"J. Pain Symptom Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/cncr.10636","article-title":"Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion","volume":"95","author":"Mercadante","year":"2002","journal-title":"Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1191\/026921600670697351","article-title":"Intravenous morphine for emergency treatment of cancer pain","volume":"14","author":"Kumar","year":"2000","journal-title":"Palliat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/0269216309346595","article-title":"The intravenous to oral relative milligram potency ratio of morphine during chronic dosing in cancer pain","volume":"24","author":"Lasheen","year":"2010","journal-title":"Palliat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.6004\/jnccn.2020.7699","article-title":"Comparing Patient-Controlled Analgesia Versus Non-PCA Hydromorphone Titration for Severe Cancer Pain: A Randomized Phase III Trial","volume":"19","author":"Lin","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.jpainsymman.2022.09.004","article-title":"Rapid Titration With Intravenous Oxycodone for Severe Cancer Pain and Oral Conversion Ratio","volume":"64","author":"Mercadante","year":"2022","journal-title":"J. Pain Symptom Manag."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9741729","DOI":"10.1155\/2017\/9741729","article-title":"Intravenous Oxycodone versus Intravenous Morphine in Cancer Pain: A Randomized, Open-Label, Parallel-Group, Active-Control Study","volume":"2017","author":"Lee","year":"2017","journal-title":"Pain Res. Manag."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1093\/jjco\/hyz145","article-title":"Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain","volume":"49","author":"Nakajima","year":"2019","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1213\/ANE.0b013e3181fec9a3","article-title":"Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration?","volume":"112","author":"Kharasch","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0304-3959(96)03313-1","article-title":"Intravenous methadone for cancer pain unrelieved by morphine and hydromorphone: Clinical observations","volume":"70","author":"Manfredi","year":"1997","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1002\/1097-0142(20011001)92:7<1919::AID-CNCR1710>3.0.CO;2-G","article-title":"Intravenous methadone in the management of chronic cancer pain: Safe and effective starting doses when substituting methadone for fentanyl","volume":"92","author":"Khojainova","year":"2001","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mercadante, S., Lo Cascio, A., and Casuccio, A. (2023). Switching to intravenous methadone in advanced cancer patients: A retrospective analysis. J. Pain Symptom Manag., in press.","DOI":"10.1016\/j.jpainsymman.2023.04.026"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3056","DOI":"10.1002\/1097-0142(20011215)92:12<3056::AID-CNCR10166>3.0.CO;2-H","article-title":"A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl","volume":"92","author":"Kornick","year":"2001","journal-title":"Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00520-010-0890-1","article-title":"Six- versus 12-h conversion method from intravenous to transdermal fentanyl in chronic cancer pain: A randomized study","volume":"19","author":"Nomura","year":"2011","journal-title":"Support. Care Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jpainsymman.2013.09.001","article-title":"Efficacy and Safety of a Six-Hour Continuous Overlap Method for Converting Intravenous to Transdermal Fentanyl in Cancer Pain","volume":"48","author":"Samala","year":"2014","journal-title":"J. Pain Symptom Manag."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/S0885-3924(03)00314-2","article-title":"Intravenous Fentanyl for Cancer Pain: A \u201cFast Titration\u201d Protocol for the Emergency Room","volume":"26","author":"Soares","year":"2003","journal-title":"J. Pain Symptom Manag."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/1049909112474112","article-title":"Intravenous Fentanyl Against Morphine Tolerance in Breakthrough Cancer Pain: A Case Series and Literature Review","volume":"31","author":"Hwang","year":"2014","journal-title":"Am. J. Hosp. Palliat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/0269216307077328","article-title":"Respiratory function during parenteral opioid titration for cancer pain","volume":"21","author":"Estfan","year":"2007","journal-title":"Palliat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/0304-3959(95)00088-7","article-title":"Experimental pain stimulates respiration and attenuates morphine-induced respiratory depression: A controlled study in human volunteers","volume":"64","author":"Borgbjerg","year":"1996","journal-title":"Pain"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/15\/3778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:18:57Z","timestamp":1760127537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/15\/3778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":33,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["cancers15153778"],"URL":"https:\/\/doi.org\/10.3390\/cancers15153778","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}