ABSTRACT
BACKGROUND AND OBJECTIVE: Despite its prevalence and impact, breakthrough pain (BTP) in chronic non-cancer pain with neuropathic component, has not been well studied and is sometimes unrecognized and often undertreated. We evaluated the efficacy of sublingual fentanyl tablet (SLF) for the treatment of BTP in opioid-tolerant patients with chronic musculoskeletal pain with neuropathic component in terms of relief of pain intensity and assessed whether hypothetical pain relief impacts on quality of life (QoL). METHODS: A multicenter, prospective, open-label study was conducted over a 30-day period. Efficacy was evaluated using a visual analogue scale (VAS) and time to onset of action of SLF. The incidence of dependence was assessed by the Leeds Dependence Questionnaire (LDQ). Changes in QoL were evaluated using the Brief Pain Questionnaire (BPI) and the EuroQol (EQ-5D). Adverse events (AE) were recorded throughout. RESULTS: 106 patients were enrolled and 105 completed the study. The average pain reduction across the study was -3.30 points [95 % confidence interval (CI) 2.9-3.7; P < 0.0001]. Pain intensity improvement from baseline was statistically significant at first assessment and all subsequent assessments (P < 0.0001). The most common AEs included nausea (33.87 %), constipation (33.06 %), somnolence (19.35 %) and vomiting (6.45 %). No significant differences were observed on LDQ (P = 0.71). QoL as measured by BPI showed statistically significant improvement in all four severity items and all interference items (P < 0.0001) and a significant improvement in the percentage of pain relief reported by patients (P < 0.0001). EQ-5D results showed a trend towards improvement. Mean self-rate health status, as measured by the EQ VAS scale increased significantly (P < 0.0001). CONCLUSION: SLF provides significant reductions in BTP intensity. The results of the BPI and EQ-5D assessments indicate that pain relief is associated with improvement of functioning and enhancement of QoL.
Subject(s)
Breakthrough Pain/drug therapy , Fentanyl/therapeutic use , Musculoskeletal Pain/drug therapy , Neuralgia/drug therapy , Administration, Sublingual , Adult , Aged , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions , Female , Fentanyl/administration & dosage , Fentanyl/adverse effects , Humans , Male , Middle Aged , Prospective Studies , TabletsABSTRACT
Se han descrito numerosas modalidades analgésicas para el control del dolor agudo postoperatorio en cirugía de rodilla, sin embargo no se ha encontrado la técnica analgésica ideal que proporcione una analgesia adecuada, preservando la función muscular y que permita una rápida recuperación funcional con escasos efectos secundarios. El bloqueo del nervio safeno a nivel del canal aductor, es un bloqueo principalmente sensitivo, que ha mostrado su utilidad para reducir el dolor y los requerimientos analgésicos en cirugía de rodilla. Es una técnica novedosa, sencilla de realizar, con escasas complicaciones descritas y de la que serán necesarios más estudios para investigar cuales son la concentración óptima y volumen de anestésico local necesario para realizar el bloqueo (AU)
Numerous analgesic varieties have been described at the management of postoperative acute pain in knee surgery, however no regional anaesthetic techniques has so far been demonstrated to be ideal to provide sufficient analgesia with preserved muscle function and to enhance a quick functional recovery with minimal side effects. Saphenous nerve block at level on the adductor canal, it is a predominant sensory blockade, has proven useful in reducing pain and analgesic requirements in knee surgery. It is a novelty technique, a simple block to perform, with few complications, and future studies will be needed to investigate the optimal volume and concentration of local anesthetic necessary to perform the blockade (AU)
