nearly all patients with malignant tumors suffer pain at the advanced stage of their disease . the treatment of cancer pain affects patient quality of life , which is closely related to cancer therapy . according to the principles of the three - step analgesic ladder , oxycodone is a first - line choice for treating moderate - to - severe cancer pain , and its controlled - release formulation , oxycontin , is a key drug for treating moderate - to - severe pain.1 oxycodone has no capping dose due to the absence of a  ceiling  effect . this article reports the use of high - dose oxycontin to treat a patient who was admitted to our hospital , with the aim of providing a reference for the clinical application of oxycodone . the time of the first oxycontin dose was used as the baseline in this report . this study was approved by the first affiliated hospital of dalian medical university , and written informed consent was obtained from the patient . a 57-year - old male patient was hospitalized for chemotherapy on november 20 , 2013 , at 1 year and 11 months after being diagnosed with small - cell lung cancer in the left lung . the patient underwent fiber optic bronchoscopy at the first affiliated hospital of dalian medical university on december 9 , 2011 . pathology results indicated small - cell lung cancer , and a diagnosis of small - cell lung cancer of the left lung was made ( limitation period ) . after the diagnosis was confirmed , the patient underwent an etoposide chemotherapy regimen ( vp-16 plus cisplatin ) . the efficacy evaluation after 2 weeks indicated stable disease ( sd ) . after an additional cycle of chemotherapy , the patient voluntarily terminated treatment due to poor compliance . the chest computed tomography ( ct ) examination on july 3 , 2012 , indicated a space - occupying mass at the hilus of the left lung , which was accompanied by obstructive pneumonia in the upper lobe of the left lung and nodules in the left lung . compared with the ct results from february 14 , 2012 , mediastinal lymph node metastases and an enlarged lesion vp-16 capsules were administered as oral chemotherapy , and sd was achieved after two treatment cycles . the treatment was stopped again due to poor patient compliance . in late july 2012 , the patient suffered hoarseness and was hospitalized because of chest tightness and shortness of breath . the patient began irinotecan and carboplatin chemotherapy on july 28 , 2012 , and completed four treatment cycles . the lung ct examination on april 3 , 2013 indicated a space - occupying mass at the hilus of the left lung , accompanied by obstructive pneumonia in the upper lobe of the left lung . compared with the ct results from january 6 , 2013 , the space - occupying mass at the hilus of the left lung was enlarged , and the inflammation in the upper lobe of the left lung was aggravated ; furthermore , both nodules in the left lung were considered malignant based on increased size , whereas the mediastinal lymph node metastases remained stable . the patient began the third - line chemotherapy regimen cav ( ifosfamide + epirubicine + vincristine ) on april 7 , 2013 , and completed four treatment cycles . in october 2013 , after consultation among different departments in our hospital , the patient began one cycle of the fourth - line pemetrexed combined cisplatin chemotherapy regimen ( pemetrexed in combination with lobaplatin ) on october 21 , 2013 . the patient was given oral ibuprofen sustained - release capsules at a dosage of 600 mg every 12 hours for right shoulder pain ( numeric rating scale [ nrs ] = 3 ) , and the pain was relieved ( nrs = 1 ) . at the time of admission , the pain manifested as dull and pricking sensations in the neck , shoulder , chest , and back , with mainly pricking pain ( nrs = 6 ) . the pain was mostly evoked by activity and was slightly relieved upon rest , with 24 episodes of breakthrough pain ( nrs = 7 ) everyday . the patient exhibited emotional irritability due to the pain , which affected his diet , sleep , and daily activities and led to his unwillingness to communicate with others . the patient received an assessment and opioid titration immediately after hospitalization . according to the recommendations in the national comprehensive cancer network guidelines for treating cancer pain , the incremental dose was calculated based on the total dose of opioid drugs within the first 24 hours , and the dose was increased for a specific time or need . the patient was first administered oxycontin on november 20 , 2013 , with titration starting at 10 mg q12h . the analgesic dosage was determined the next day at 40 mg q12h and was increased to 120 mg q12h after 1 month . the dosage was increased to 660 mg q12h in january 2014 , but there was no improvement in pain management associated with the dosage increase . therefore , the dosage was reduced to 600 mg q12h . later , because the analgesic effect did not last for 12 hours and the patient refused to take the drug at an incremental dose each time , 600 mg q8h was attempted . the patient was given 50 mg oral morphine immediate - release tablets , 25 times per day , at the onset of breakthrough pain . the nrs score was 23 after analgesic treatment , with only difficulty in urination during treatment . however , at the end stage of the disease , the patient was in poor physical condition , with a performance status ( ps ) score of 34 and brain metastasis . it was unclear whether there was spinal cord metastasis that caused spinal cord compression , and there was insufficient evidence to prove whether the symptoms were related to the drugs . no other obvious adverse reactions were observed . during the period when oxycontin was used , ibuprofen controlled - release capsules , carbamazepine , gabapentin , and alprazolam were utilized as adjuvant medications based on symptoms and clinical reactions ( table 1 ) . after two cycles of chemotherapy with pemetrexed combined with lobaplatin , the efficacy assessment indicated pd . after considering the report on chemotherapy - sensitive genes and the toxicity prediction for the patient , he began to take oral gimeracil and oteracil potassium capsules as fifth - line monotherapy on december 2 , 2013 . the patient received one cycle of docetaxel combined with cisplatin as sixth - line chemotherapy . the patient was hospitalized on february 8 , 2014 , with a ps score of 3 and poor appetite , and received best supportive care . the cause of death was end - stage lung cancer and respiratory failure ( table 2 ) . the patient was given oral ibuprofen sustained - release capsules at a dosage of 600 mg every 12 hours for right shoulder pain ( numeric rating scale [ nrs ] = 3 ) , and the pain was relieved ( nrs = 1 ) . at the time of admission , the pain manifested as dull and pricking sensations in the neck , shoulder , chest , and back , with mainly pricking pain ( nrs = 6 ) . the pain was mostly evoked by activity and was slightly relieved upon rest , with 24 episodes of breakthrough pain ( nrs = 7 ) everyday . the patient exhibited emotional irritability due to the pain , which affected his diet , sleep , and daily activities and led to his unwillingness to communicate with others . the patient received an assessment and opioid titration immediately after hospitalization . according to the recommendations in the national comprehensive cancer network guidelines for treating cancer pain , the incremental dose was calculated based on the total dose of opioid drugs within the first 24 hours , and the dose was increased for a specific time or need . the patient was first administered oxycontin on november 20 , 2013 , with titration starting at 10 mg q12h . the analgesic dosage was determined the next day at 40 mg q12h and was increased to 120 mg q12h after 1 month . the dosage was increased to 660 mg q12h in january 2014 , but there was no improvement in pain management associated with the dosage increase . therefore , the dosage was reduced to 600 mg q12h . later , because the analgesic effect did not last for 12 hours and the patient refused to take the drug at an incremental dose each time , 600 mg q8h was attempted . the patient was given 50 mg oral morphine immediate - release tablets , 25 times per day , at the onset of breakthrough pain . the nrs score was 23 after analgesic treatment , with only difficulty in urination during treatment . however , at the end stage of the disease , the patient was in poor physical condition , with a performance status ( ps ) score of 34 and brain metastasis . it was unclear whether there was spinal cord metastasis that caused spinal cord compression , and there was insufficient evidence to prove whether the symptoms were related to the drugs . no other obvious adverse reactions were observed . during the period when oxycontin was used , ibuprofen controlled - release capsules , carbamazepine , gabapentin , and alprazolam were utilized as adjuvant medications based on symptoms and clinical reactions ( table 1 ) . after two cycles of chemotherapy with pemetrexed combined with lobaplatin , the efficacy assessment indicated pd . after considering the report on chemotherapy - sensitive genes and the toxicity prediction for the patient , he began to take oral gimeracil and oteracil potassium capsules as fifth - line monotherapy on december 2 , 2013 . the patient received one cycle of docetaxel combined with cisplatin as sixth - line chemotherapy . the patient was hospitalized on february 8 , 2014 , with a ps score of 3 and poor appetite , and received best supportive care . the cause of death was end - stage lung cancer and respiratory failure ( table 2 ) . oral administration is the dosing route preferred by the world health organization and the european association for palliative care for drugs that treat cancer pain . it acts on both  and  receptors and has been shown to be effective in treating different types of pain ( eg , somatic pain , visceral pain , and neuropathic pain ) , especially neuropathic pain . the drug has characteristics of both immediate release and sustained release , with a time to onset and peak similar to those of immediate - release morphine . oxycontin is currently the first - choice drug for treating moderate - to - severe pain.2 comprehensive and dynamic assessments of cancer pain form the basis of personalized dosing regimens.3 the initial assessment is usually completed within 24 hours after a patient is hospitalized . a comprehensive assessment is conducted again after 3 days of analgesic treatment or when the cancer pain has been stably relieved . in principle , the pain assessment is performed at least twice each month . the patient in this report received a complete evaluation after being hospitalized , and dosage titrations , pain assessments , and adverse event monitoring were performed during the entire cancer pain treatment process . during this period , the patient and his family cooperated , and the patient showed good compliance , unlike in the initial treatment stage . at the end stage of the disease , the analgesic effect of oxycontin at 600 mg q12h did not last for 12 hours , and the patient refused to take additional dose increments at each drug administration . therefore , oral administration of 600 mg oxycontin q8h was attempted , and the daily dose reached 1,800 mg . this dosage was sufficient for daily pain management , but breakthrough pain episodes could not be avoided . the most common adverse reactions of opioid drugs are gastrointestinal reactions such as nausea , vomiting , and constipation.4 in the clinic , when metoclopramide poorly controls vomiting , a low - dose oral hormone can be added to increase patient appetite and alleviate adverse reactions . it has mild adverse reactions and is well tolerated , thereby reasonably reducing the use of stimulant laxatives . respiratory depression is a life - threatening side effect of opioid drugs , especially when they are used at high doses , when a combination of analgesic drugs is used , or when high - dose morphine is intrathecally administered . despite the low incidence of respiratory depression a clinically feasible method is to monitor oxygen saturation in blood , but this method has low sensitivity . when the daily dose of oxycontin reached 1,800 mg , which is equivalent to 2,400 mg of morphine , the patient did not exhibit respiratory depression or other mental symptoms that are usually caused by morphine , such as drowsiness , euphoria , and cognitive changes.5 this observation suggests that the safety of oxycontin is more clinically acceptable . he had brain metastases ; therefore , it is unknown whether the difficulty in urination was caused by spinal cord compression by spinal cord metastases . although this dosage is not recommended in the guidelines , it is necessary to ascertain the general condition of each patient in clinical practice , and a personalized analysis and approach can be adopted in the application of analgesic drugs ; the primary goal is to ensure an acceptable quality of life for the patient and to enable the patient to live with dignity.6 during the treatment of cancer pain , chemotherapy was constantly attempted in an effort to control tumor progression and thereby alleviate patient suffering . during the episodes of sd , the cancer pain was under control , indicating that chemotherapy is an important treatment for cancer pain . although data from this patient indicate that high - dose oxycontin is safe , we are unsure whether this dose can be utilized in other patients ; even at a lower dose , this drug may cause serious , even life - threatening , adverse reactions in other patients . based on communications at national conferences , cases in which high doses were utilized have been reported by other organizations , but recognized evidence is not yet available . moreover , we can not determine the highest clinical dose of oxycontin based on a few cases because we can not blindly pursue the goal of completely eradicating pain while ignoring potential concerns regarding side effects , which may have terrible consequences . certainly , we expect more data , particularly from large - scale clinical research , to support our conclusion . there is much to be learned about the treatment of cancer pain , and we will continue to explore this aspect of patient management . chronic cancer pain has a long disease course , which could easily cause complex psychological symptoms due to their important role in the pain experience . psychological drug interventions include tricyclic antidepressants , benzodiazepine sedatives , and other nonmedication - based therapies.7 adjuvant drugs were added during the treatment of this patient based on his situation , but they failed to achieve the expected desirable effect . regarding nondrug - based treatments , the patient should be guided in self - adjustment , with an emphasis on educating the patient and their family members to strengthen self - administered pain assessments and management by teaching them how to assess the intensity and nature of their pain and to monitor adverse reactions . to effectively prevent pain , patient compliance with the treatment regimen should be improved , their confidence in the analgesic treatment should be enhanced , and they should be kept in a pleasant mood.8 in summary , pain is controllable , and patients have a right to experience no pain . rational personalized treatment of cancer pain can improve patient quality of life , relieve pain , and help prolong patient survival .
pain management is an important topic that has received extensive attention from clinical practitioners . 
 nearly all patients with malignant tumors suffer pain at the advanced stage of their disease . 
 oxycodone is a first - line choice for treating moderate - to - severe cancer - related pain , and oxycontin , a controlled - release oxycodone hydrochloride tablet , is internationally recognized as a safe and effective opioid analgesic . 
 oxycontin has the characteristics of both immediate release and sustained release , with a time to onset and peak similar to those of immediate - release morphine . 
 it acts on both  and  receptors and has been shown to be effective in treating different types of pain , especially neuropathic pain , theoretically without a dose cap . however , the dose is limited in clinical applications due to various factors that are likely to affect its analgesic effect and reduce patient quality of life . cooperation with a patient s family members 
 is required during the treatment of cancer pain . 
 chronic cancer pain has a long disease course , which could easily cause complex psychological symptoms due to their important role in the pain experience . 
 pain is controllable , and patients have a right to not experience pain . 
 an optimal living state can be achieved through collaboration between physicians and patients . 
 rational personalized treatment of cancer pain can improve patient quality of life , relieve pain , and help prolong patient survival . 
 this article reports the treatment procedure and adverse reactions in a patient who was treated with high - dose oxycontin , with the aim of providing a reference for other clinical practitioners .