Titration with Oxymorphone Extended Release to Achieve Effective Long-Term Pain Relief and Improve Tolerability in Opioid-Naive Patients with Moderate to Severe Pain


Richard Rauck, MD, Carolinas Pain Institute, Wake Forest University, 145 Kimel Park Drive, Winston-Salem, NC 27103, USA. Tel: 336-765-6181; Fax: 336-765-8492; E-mail: rrauck@ccrpain.com.


Objective.  Assess the effectiveness and tolerability of a program of gradual dose titration with oxymorphone extended release (ER) for treatment of moderate to severe chronic pain in opioid-naive patients.

Design.  Open-label, nonrandomized 6-month study with a titration/stabilization period of ≤1 month followed by a 5-month maintenance period.

Setting.  Multidisciplinary pain centers in the United States.

Patients.  Adult opioid-naive patients with moderate to severe chronic pain.

Interventions.  Patients were gradually titrated from a 5-mg dose of oxymorphone ER (taken every 12 hours) to a stabilized dose that provided effective pain relief and was well tolerated.

Outcome Measures.  Brief Pain Inventory Short Form questions 5 and 9, patient and physician global assessments of pain relief, adverse events (AEs), and discontinuations.

Results.  The majority (94/126; 75%) of patients were stabilized on a dose of oxymorphone ER that provided effective pain relief with tolerable AEs. Most (81/94; 86%) required <24 days to reach a stable dose. Sixteen percent of patients in the titration period and 17% of patients in the maintenance period discontinued because of AEs possibly or probably related to oxymorphone ER. Patients completing the entire 5-month maintenance period experienced effective pain relief with significant (>50%) reductions of pain interference with quality-of-life measures. There was minimal dose escalation over the 5 months and low use of rescue medication.

Conclusions.  Oxymorphone ER provided effective pain relief from moderate to severe chronic pain in opioid-naive patients. Gradual titration was well tolerated, with a low rate of discontinuations caused by AEs.