Caffeine as an adjuvant therapy to opioids in cancer pain

A randomized, double-blind, placebo-controlled trial

Sang Yeon Suh, Youn Seon Choi, Sang Cheul Oh, Young Sung Kim, Kyunghee Cho, Woo Kyung Bae, Ju Hyun Lee, Ah Ram Seo, Hong Yup Ahn

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Context: Opioid therapy often shows insufficient efficacy and substantial adverse events in patients with advanced cancer. Objectives: To assess the efficacy of caffeine infusion as an adjuvant analgesic to opioid therapy in patients with advanced cancer. Methods: A double-blind, randomized, placebo-controlled trial was conducted in the palliative care wards of two teaching hospitals in South Korea. A total of 20 of 41 participants were assigned to the caffeine group and 21 to the placebo group. The participants received caffeine (200 mg) or normal saline intravenously once a day for two days. The primary outcome was pain, which was measured using a 10-point rating scale. Other outcomes included drowsiness, confusion, nausea, sleep disturbance, fatigue, and sadness. Results: Three participants (two in the caffeine group and one in the placebo group) dropped out after the first intervention because of insomnia; thus, 38 participants completed the trial. Pain score was significantly lower in the caffeine group than in the placebo group after the second trial (P = 0.038). The mean reduction in pain intensity in the caffeine group was 0.833 (95% confidence interval [CI] 0.601-1.066), whereas that in the placebo group was 0.350 (95% CI 0.168-0.532). Considering an improvement higher than 30% from baseline as the threshold value, drowsiness improved significantly in the caffeine group after the first trial (P = 0.041). Adverse event rate did not differ between the two groups. Conclusion: Caffeine infusion significantly reduced pain and drowsiness, but the reduction did not reach clinical significance in patients with advanced cancer undergoing opioid therapy. Further investigations are warranted.

Original languageEnglish
Pages (from-to)474-482
Number of pages9
JournalJournal of Pain and Symptom Management
Volume46
Issue number4
DOIs
Publication statusPublished - 2013 Oct 1

Fingerprint

Caffeine
Opioid Analgesics
Placebos
Sleep Stages
Pain
Therapeutics
Confidence Intervals
Confusion
Neoplasms
Republic of Korea
Cancer Pain
Sleep Initiation and Maintenance Disorders
Palliative Care
Double-Blind Method
Teaching Hospitals
Nausea
Fatigue
Sleep
Randomized Controlled Trials

Keywords

  • Caffeine
  • cancer pain
  • opioid therapy
  • randomized controlled trial

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Nursing(all)

Cite this

Caffeine as an adjuvant therapy to opioids in cancer pain : A randomized, double-blind, placebo-controlled trial. / Suh, Sang Yeon; Choi, Youn Seon; Oh, Sang Cheul; Kim, Young Sung; Cho, Kyunghee; Bae, Woo Kyung; Lee, Ju Hyun; Seo, Ah Ram; Ahn, Hong Yup.

In: Journal of Pain and Symptom Management, Vol. 46, No. 4, 01.10.2013, p. 474-482.

Research output: Contribution to journalArticle

Suh, Sang Yeon ; Choi, Youn Seon ; Oh, Sang Cheul ; Kim, Young Sung ; Cho, Kyunghee ; Bae, Woo Kyung ; Lee, Ju Hyun ; Seo, Ah Ram ; Ahn, Hong Yup. / Caffeine as an adjuvant therapy to opioids in cancer pain : A randomized, double-blind, placebo-controlled trial. In: Journal of Pain and Symptom Management. 2013 ; Vol. 46, No. 4. pp. 474-482.
@article{59ac37a75ae843c4aeb12f5e2ccdb4de,
title = "Caffeine as an adjuvant therapy to opioids in cancer pain: A randomized, double-blind, placebo-controlled trial",
abstract = "Context: Opioid therapy often shows insufficient efficacy and substantial adverse events in patients with advanced cancer. Objectives: To assess the efficacy of caffeine infusion as an adjuvant analgesic to opioid therapy in patients with advanced cancer. Methods: A double-blind, randomized, placebo-controlled trial was conducted in the palliative care wards of two teaching hospitals in South Korea. A total of 20 of 41 participants were assigned to the caffeine group and 21 to the placebo group. The participants received caffeine (200 mg) or normal saline intravenously once a day for two days. The primary outcome was pain, which was measured using a 10-point rating scale. Other outcomes included drowsiness, confusion, nausea, sleep disturbance, fatigue, and sadness. Results: Three participants (two in the caffeine group and one in the placebo group) dropped out after the first intervention because of insomnia; thus, 38 participants completed the trial. Pain score was significantly lower in the caffeine group than in the placebo group after the second trial (P = 0.038). The mean reduction in pain intensity in the caffeine group was 0.833 (95{\%} confidence interval [CI] 0.601-1.066), whereas that in the placebo group was 0.350 (95{\%} CI 0.168-0.532). Considering an improvement higher than 30{\%} from baseline as the threshold value, drowsiness improved significantly in the caffeine group after the first trial (P = 0.041). Adverse event rate did not differ between the two groups. Conclusion: Caffeine infusion significantly reduced pain and drowsiness, but the reduction did not reach clinical significance in patients with advanced cancer undergoing opioid therapy. Further investigations are warranted.",
keywords = "Caffeine, cancer pain, opioid therapy, randomized controlled trial",
author = "Suh, {Sang Yeon} and Choi, {Youn Seon} and Oh, {Sang Cheul} and Kim, {Young Sung} and Kyunghee Cho and Bae, {Woo Kyung} and Lee, {Ju Hyun} and Seo, {Ah Ram} and Ahn, {Hong Yup}",
year = "2013",
month = "10",
day = "1",
doi = "10.1016/j.jpainsymman.2012.10.232",
language = "English",
volume = "46",
pages = "474--482",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Caffeine as an adjuvant therapy to opioids in cancer pain

T2 - A randomized, double-blind, placebo-controlled trial

AU - Suh, Sang Yeon

AU - Choi, Youn Seon

AU - Oh, Sang Cheul

AU - Kim, Young Sung

AU - Cho, Kyunghee

AU - Bae, Woo Kyung

AU - Lee, Ju Hyun

AU - Seo, Ah Ram

AU - Ahn, Hong Yup

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Context: Opioid therapy often shows insufficient efficacy and substantial adverse events in patients with advanced cancer. Objectives: To assess the efficacy of caffeine infusion as an adjuvant analgesic to opioid therapy in patients with advanced cancer. Methods: A double-blind, randomized, placebo-controlled trial was conducted in the palliative care wards of two teaching hospitals in South Korea. A total of 20 of 41 participants were assigned to the caffeine group and 21 to the placebo group. The participants received caffeine (200 mg) or normal saline intravenously once a day for two days. The primary outcome was pain, which was measured using a 10-point rating scale. Other outcomes included drowsiness, confusion, nausea, sleep disturbance, fatigue, and sadness. Results: Three participants (two in the caffeine group and one in the placebo group) dropped out after the first intervention because of insomnia; thus, 38 participants completed the trial. Pain score was significantly lower in the caffeine group than in the placebo group after the second trial (P = 0.038). The mean reduction in pain intensity in the caffeine group was 0.833 (95% confidence interval [CI] 0.601-1.066), whereas that in the placebo group was 0.350 (95% CI 0.168-0.532). Considering an improvement higher than 30% from baseline as the threshold value, drowsiness improved significantly in the caffeine group after the first trial (P = 0.041). Adverse event rate did not differ between the two groups. Conclusion: Caffeine infusion significantly reduced pain and drowsiness, but the reduction did not reach clinical significance in patients with advanced cancer undergoing opioid therapy. Further investigations are warranted.

AB - Context: Opioid therapy often shows insufficient efficacy and substantial adverse events in patients with advanced cancer. Objectives: To assess the efficacy of caffeine infusion as an adjuvant analgesic to opioid therapy in patients with advanced cancer. Methods: A double-blind, randomized, placebo-controlled trial was conducted in the palliative care wards of two teaching hospitals in South Korea. A total of 20 of 41 participants were assigned to the caffeine group and 21 to the placebo group. The participants received caffeine (200 mg) or normal saline intravenously once a day for two days. The primary outcome was pain, which was measured using a 10-point rating scale. Other outcomes included drowsiness, confusion, nausea, sleep disturbance, fatigue, and sadness. Results: Three participants (two in the caffeine group and one in the placebo group) dropped out after the first intervention because of insomnia; thus, 38 participants completed the trial. Pain score was significantly lower in the caffeine group than in the placebo group after the second trial (P = 0.038). The mean reduction in pain intensity in the caffeine group was 0.833 (95% confidence interval [CI] 0.601-1.066), whereas that in the placebo group was 0.350 (95% CI 0.168-0.532). Considering an improvement higher than 30% from baseline as the threshold value, drowsiness improved significantly in the caffeine group after the first trial (P = 0.041). Adverse event rate did not differ between the two groups. Conclusion: Caffeine infusion significantly reduced pain and drowsiness, but the reduction did not reach clinical significance in patients with advanced cancer undergoing opioid therapy. Further investigations are warranted.

KW - Caffeine

KW - cancer pain

KW - opioid therapy

KW - randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=84885291188&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885291188&partnerID=8YFLogxK

U2 - 10.1016/j.jpainsymman.2012.10.232

DO - 10.1016/j.jpainsymman.2012.10.232

M3 - Article

VL - 46

SP - 474

EP - 482

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

IS - 4

ER -