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AIM: To compare the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) and oral morphine in Indian patients with breakthrough episodes of cancer pain. MATERIALS AND METHODS: In this randomized, open label, active controlled, clinical study, total 186 patients who regularly experienced 1-4 episodes of breakthrough cancer pain (BTCP) daily, over the persistent pain controlled by taking oral morphine 60 mg/day or its equivalent were randomized to receive either OTFC 200 mcg or oral morphine 10 mg for the treatment of BTCP for 3 days. Improvement in pain as determined by numerical rating scale (NRS) at 5, 15, 30, and 60 minutes of drug administration and percentage of BTCP episodes showing reduction in pain intensity by >33% at 15 minutes were primary efficacy endpoints. Secondary efficacy endpoints were requirement for rescue analgesia and global assessment by physician and patient. Data of both treatment groups were analysed by appropriate statistical test using software, STATISTICA, version 11. RESULTS: Patients treated with OTFC experienced significantly greater improvement in pain intensity of breakthrough episodes compared to those treated with oral morphine at all assessment time points (P < 0.0001). 56% of breakthrough pain episodes treated with OTFC showed a greater than 33% reduction in pain intensity from baseline at 15 minutes compared to 39% episodes treated with oral morphine (P < 0.0001). Patient's and physician's global assessment favoured OTFC than oral morphine (P < 0.0001). Requirement of rescue analgesia in both the study groups was similar (P > 0.05). Both study drugs were well tolerated. CONCLUSIONS: OTFC was found to provide faster onset of analgesic effect than immediate release oral morphine in management of breakthrough cancer pain.
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BACKGROUND AND AIM: Under-treatment of pain is a global phenomenon and the basic knowledge of pain amongst health care providers continues to be deficient. The aim of this study was to determine the basic prevalent knowledge of pain among Indian anaesthesiologists and the impact of a pain educational programme on their existing knowledge. METHODS: A nine lectures pain continuing medical education (CME) program was conducted for 114 young anaesthesiologists. All delegates were given 21-item questionnaire in a pre and post-test design. The 69 paired responses were compared for individual questions using McNemar test and the overall improvement in knowledge was analysed using paired t-test. RESULTS: The pre-test score for correct answers was 61.9%. The post-test score was 69.8% and this improvement was found to be statistically significant (P < 0.001). A significant improvement in perception was detected that 'opioids usage was less likely to cause addiction' (correct responses increased from 4.2 to 77.4%, P = 0.001). CONCLUSION: The questionnaire study found that the current basic knowledge about pain amongst young anaesthesiologists is deficient. The physician's major concerns were opioid addiction and respiratory depression with opioid usage. The results of pre and post-test questionnaire survey have shown that pain education can help in improving knowledge of pain management.
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BACKGROUND AND AIMS: Acute neuropathic pain (ANP) is an under-recognised and under-diagnosed condition and often difficult to treat. If left untreated, it may further transform into persistent post-operative chronic pain leading to a disability. AIMS: This prospective study was undertaken on 300 patients to identify the prevalence of ANP in the post-operative period by using a neuropathic pain detection questionnaire tool. METHODS: This is an open-label study in which patients with six different types of cancer surgeries (Thoracic, gastro-intestinal, gynae/urology, bone/soft-tissue, head and neck and breast subgroups-50 each) were included for painDETECT questionnaire tool on the 2(nd) and 7(th) day surgery. RESULTS: This study found a 10% point prevalence of ANP. Analysis showed that 25 patients had 'possible' ANP, the maximum from urological cancer surgery (6) followed by thoracic surgery (5). Five patients were found to have 'positive' ANP including 2 groin node dissection, 2 hemipelvectomy and 1 oesophagectomy. CONCLUSION: Significant relationship between severity of post-operative pain was found with the occurrence of ANP in the post-operative period requiring a special attention to neuropathic pain assessment. Larger studies are required with longer follow-up to identify accurately the true prevalence and causative factors of ANP after surgery.
ABSTRACT
INTRODUCTION: Under treatment of pain is a recognized global issue. Opioid analgesic medication is the mainstay of treatment in cancer patients as per the World Health Organization (WHO) pain relief ladder, yet 50% of cancer patients worldwide do not receive adequate pain relief or are undertreated. AIM: The aim of this study was to audit the ongoing opioid-prescribing practices in our tertiary cancer pain clinic during January-June 2010. MATERIALS #ENTITYSTARTX00026; METHODS: The prescribed type of opioid, dose, dosing interval, and laxatives details were analyzed. RESULTS: Five hundred pain files were reviewed and 435 were found complete for audit. Three hundred forty-eight (80%) patients were prescribed opioids. Two hundred fifty-nine (74.4%) received weak opioids while 118 (33.9%) received strong opioids. A total of 195 (45%) patients had moderate and 184 (42%) had severe pain. Ninety-three (26.7%) patients received morphine; however, only 31.5% (58 of 184) in severe pain received morphine as per the WHO pain ladder. Only 73 of 93 (78.4%) patients received an adequate dose of morphine with an adequate dosing interval and only 27 (29%) were prescribed laxatives with morphine. CONCLUSION: This study shows that the under treatment of pain and under dosing of opioids coupled with improper side effect management are major issues.
