Clinical Usefulness of Long-term Application of Fentanyl Matrix in Chronic Non-Cancer Pain: Improvement of Pain and Physical and Emotional Functions

BACKGROUND: Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS: This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS: The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS: The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

The impact of breast cancer on the emotional component of health.

Aim: The aim of this study was to examine how the breast cancer affects the quality of life of women, especially in the emotional component of health compared to women without this disease in our community. Study Design: Cross-sectional study. Place and Duration of Study: Department of Social Medicine, Medical Faculty, University of Banja Luka with the Association of women “Iskra” and the Association of nurses from Banja Luka, Bosnia and Herzegovina, from 10 June to 15 August 2011. Methodology: The study included 100 women treated for breast cancer from “Iskra" Banja Luka and 100 women from the Association of nurse aged 20-75, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: In monitoring the parameters on functional scales in women treated for breast cancer, the score for emotional scale and social functioning has shown the lowest value, with a statistically significant difference compared to the highest score in cognitive and physical functioning. Changes in emotional scale at large were associated with symptoms that occur in women treated for breast cancer, where nearly ½ (48%) of those women had pain and the pain interfered with the daily activities. Insomnia was present quite a bit (53%) and very much (5%) in women treated for breast cancer. In women treated for breast cancer, a statistically significant difference was found in scores for symptoms of fatigue, insomnia and pain in relation to other symptoms which were present to a lesser extent. More than 2/3 (73%) said they were concerned about their health in the future. Conclusion: Changes on emotional scale indicate the need to monitor the quality of emotional health of patients treated for breast cancer in order to implement preventive programs to help women treated for breast cancer to cope with this problem.