Hydromorphone for the treatment of cancer pain | Figure 1

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Hydromorphone for the treatment of cancer pain

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Over 75% of people with cancer experience pain. Around 30% to 50% of these people have moderate to severe pain, which can have a negative impact on daily life. Cancer pain is a distressing symptom that tends to worsen as the disease progresses. Hydromorphone may help relieve these symptoms. Cancer‐related pain is usually treated with medicines such as morphine, oxycodone, fentanyl or hydromorphone. This review looked at the benefits and harms of hydromorphone compared with other medicines.

We found four studies that compared hydromorphone with oxycodone, three studies that compared hydromorphone with morphine and one study that compared hydromorphone with fentanyl.

This review includes eight studies (four new studies included in this updated version) with 1283 participants comparing hydromorphone with oxycodone, morphine or fentanyl in adults (aged 18 years and above) with moderate to severe cancer pain. None of the studies compared hydromorphone and placebo. None of the studies included children.

We found no differences in pain intensity scores between the different treatment groups and on average patients reported low levels of pain after opioid administration. Hydromorphone seemed to work as well as morphine, oxycodone and fentanyl. There were some side effects, such as nausea, vomiting, dizziness and constipation, but generally there was no clear difference between people taking hydromorphone and people taking morphine, oxycodone or fentanyl.

We rated the certainty of the evidence from studies using four levels: very low, low, moderate or high. Very low‐certainty evidence means that we are very uncertain about the results. High‐certainty evidence means that we are very confident in the results. No results were rated as high certainty; we only identified very low‐certainty evidence for pain intensity, pain relief and side effects. These outcomes were rated as very low certainty because there were either few trials included with few participants, or due to other sources of bias, such as potential competing interests with the pharmaceutical industry.

The studies did not provide enough high‐certainty evidence to draw firm conclusions; the evidence of the benefits and harms of hydromorphone compared with other medicines is very uncertain.

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