Opioid-induced constipation in chronic pain: Experience with 180 patients.

BACKGROUND: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC. METHODS AND PATIENTS: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (>1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine. The degree of constipation was evaluated using the Bowel Function Index (BFI). RESULTS: Out of 180 enrolled patients (median age: 61.5 years, 66.7 percent women, mean treatment duration: 3 years), 57.2 percent suffered from nociceptive pain, 33.9 percent from mixed pain, and 8.9 percent from neuropathic pain. The most commonly prescribed opioids were oxycodone/naloxone (44.4 percent) and tapentadol (37.8 percent). At the time of the study, 73.9 percent of patients had constipation (BFI > 29), and 21.7 percent had severe constipation (BFI > 69). In a multiple linear regression analysis, previous constipation, morphine equivalent dose, treatment with fentanyl and interaction between morphine equivalent dose and hydromorphone were associated with more severe constipation. CONCLUSIONS: Most patients receiving long-term treatment with opioids present symptoms of constipation. The bowel function profile was more favorable for tapentadol and oxycodone, with no differences between them, even though morphine equivalent doses were on average higher in the tapentadol group.

Changes in Quality of Life after 3 months of Usual Care in a Large Sample of Patients with Noncancer Pain: The "QOOL: Quality of Life and Pain" Study.

Large-scale observational studies can provide useful information on changes in health outcomes over time. The aim of this study was to investigate the effect of 3 months of usual care on quality of life (QOL) and pain outcomes in noncancer chronic pain patients managed by pain specialists and to examine factors associated with changes in QOL. This was assessed using the EQ-5D and pain outcomes using the Brief Pain Inventory (BPI). Changes in QOL and pain were studied for the overall sample and in subgroups defined by baseline pain severity. Multivariate regression was used to investigate factors associated with change on EQ-5D. Three thousand and twenty-nine patients were included for analysis. After 3 months of usual care, a mean of 40.9% of patients showed improvement on individual EQ-5D dimensions, with the highest rates of improvement seen on the pain/discomfort (50.8%) and anxiety/depression (48.3%) dimensions. The EQ-5D Index increased from a mean (SD) of 0.35 (0.2) to 0.58 (0.21) points between baseline and month 3, and the thermometer from 41.5 (19.4) to 58.7 (17.8), indicating a large effect. Improvements in QOL were larger in those with severe baseline pain. The BPI severity summary score improved from a mean (SD) of 6.5 (1.4) to 4.1 (1.7) and the interference summary score from 6.6 (1.5) to 4.2 (1.9). Changes on the BPI severity and interference scores were associated with changes in the EQ-5D Index and thermometer. In conclusion, 3 months of usual care in noncancer pain patients led to substantial improvements in QOL and pain outcomes.

Validation of the Short Form of the Brief Pain Inventory (BPI-SF) in Spanish Patients with Non-Cancer-Related Pain.

The Brief Pain Inventory (BPI) is a widely used pain measurement tool. There are 2 versions, the BPI Long Form (BPI-LF) and Short Form (BPI-SF), which share 2 core scales measuring pain severity and pain interference but which use different recall periods (24 hours vs. 1 week). To date, the BPI-SF has not been validated for use in Spain. This study investigated the psychometric properties of the BPI-SF Spanish version and compared results on the core scales between BPI-LF and BPI-SF. The data came from a 3-month observational study of 3,029 nononcologic patients managed in Spanish pain units. The BPI-SF's reliability, validity, and responsiveness were assessed. The effect of different recall periods was investigated by using intraclass correlation coefficients (ICCs) to determine the strength of correlation between BPI-LF and BPI-SF. The BPI-SF showed good reliability, with Cronbach's alphas of 0.931 for the severity and interference scales, which also discriminated well between patients reporting different levels of quality of life on EuroQol-5D dimensions (between group effect sizes [ESs] over 0.8). Substantial improvements were seen on both subscales after 3 months of treatment (ES of 1.76 for pain severity and 1.51 for pain interference). Recall period did not noticeably affect scores; ICCs (95% CI) between the long and short versions were 0.946 (0.938 to 0.954) and 0.929 (0.919 to 0.939) for the severity and interference subscales, respectively. The Spanish version of the BPI-SF is a valid and reliable instrument to measure pain severity and interference.

Efficacy of sublingual fentanyl vs. oral morphine for cancer-related breakthrough pain.

INTRODUCTION: Breakthrough cancer pain (BTcP) is recognized as a clinically significant complication of chronic cancer pain with most BTcP episodes peaking in intensity within a few minutes and lasting for approximately 30 min. Although a number of rapid-onset fentanyl preparations have been developed in the last decade, BTcP is still typically managed through the use of rescue doses of oral morphine but a comparative study of sublingual fentanyl and oral morphine is still lacking. The aim of this study was to determine the efficacy, tolerability, and patient satisfaction of sublingual fentanyl citrate (SLF) and oral morphine solution (OM) in the treatment of BTcP. METHODS: In this prospective, longitudinal, controlled-study, 40 patients with BTcP were allocated to receive oral morphine (OM) or sublingual fentanyl (SLF). Pain intensity level on a 0-10 numerical rating visual analog scale (VAS), frequency of BTcP throughout the day, onset of relief (0-5, 6-10, 11-15, or over 16 min), time required for dose titration, patient satisfaction and adverse effects were assessed at 3, 7, 15, and 30 days after starting the treatment. RESULTS: Mean doses of opioids for BTcP were 235 ± 23.4 µg (SLF) and 38 ± 5.2 mg (OM). The mean pain intensity levels were significantly lower with SLF than OM at 3 days (6.0 vs. 6.95; p = 0,001), 7 days (4.15 vs. 6.25, p < 0.001), 15 days (3.45 vs. 5.35, p < 0.001), and 30 days (3.05 vs. 4.45, p < 0.001). SLF provided significantly faster relief for BTcP than OM (p < 0.001) with a shorter dose titration period (mean 6.6 ± 3.3 vs. 13.3 ± 4.9 days; p < 0.001) and better satisfaction scores and with a very good safety profile. CONCLUSIONS: Administration of SLF might provide a more effective treatment option than oral morphine for BTcP.