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Abstract
While morphine is historically the gold standard for the management of severe cancer
pain, some patients either do not achieve adequate analgesia, or suffer intolerable
side effects from this drug. For these patients, alternatives such as hydromorphone
are recommended. This review explores the evidence for the efficacy of hydromorphone
in the management of pain. A systematic search, from 1966 to 2000, of published and
unpublished randomized trials that involved the administration of hydromorphone for
both acute and chronic pain conditions in adults and children, was conducted. Forty-three
studies were included in the review; 11 involved chronic cancer pain and 32 acute
pain. Approximately half the studies received a low quality score. In addition, the
heterogeneity of the studies precluded combination of data and results. Overall, hydromorphone
appears to be a potent analgesic. The limited number of studies available suggests
that there is little difference between hydromorphone and other opioids in terms of
analgesic efficacy, adverse effect profile and patient preference. However, most studies
involved small numbers of patients and wide ranges in equianalgesic dose ratios, making
it difficult to determine real differences between interventions.