ABSTRACT
OBJECTIVES AND METHOD: The success of effective pain treatment can best be established on the basis of a multidimensional assessment of the patient's quality of life. Within the framework of a prospective multicentre observational study, patients suffering from chronic pain were investigated for impairment of quality of life in regard to 32 different activities. The phase prior to and during treatment with fentanyl-TTS were compared. A total of 6677 patients were included in the study. The source of the pain was, forthe most part, non-tumor-related diseases. Some 64% of the patients were dissatisfied with their prior medication. The analgesics included nonopioid substances and both weak and strong opioids. 18% of the patients had received no prior opioid medication. RESULTS: During the two-month period under observation, pain intensity decreased from an average of 7.6 +/- 1.3 to 3.1 +/- 1.6 on the visual analog scale. With regard to quality of life, more than 80% of the patients experienced an appreciable improvement. Pain reduction was particularly common in patients with pain associated with the locomotor system, where an improvement in particular in walking, mobility or driving ability and good pain control was reported. In the area of sexuality, too, a significant improvement in quality of life was to be seen. Tolerability was good. CONCLUSION: Chronic pain can be effectively treated with fentanyl-TTS, which has a very favorable side effect profile. The reduction in pain led to an appreciable improvement in quality of life in all the areas reported bythe patients.
Subject(s)
Analgesics, Opioid/administration & dosage , Fentanyl/administration & dosage , Pain/drug therapy , Pain/psychology , Quality of Life/psychology , Administration, Cutaneous , Adolescent , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Child , Chronic Disease , Female , Fentanyl/adverse effects , Humans , Male , Middle Aged , Pain/etiology , Pain Measurement , Patient Satisfaction , Prospective Studies , Sick RoleABSTRACT
AIM: Efficacy and tolerability of analgesic treatment with fentanyl-TTS (Durogesic) for pain caused by arthrosis was investigated. METHOD: Treatment with fentanyl-TTS was started for the first time in patients with severe pain caused by coxarthrosis and/or gonarthrosis and was prospectively documented for 30 days. Pain was assessed by the patient with an 11-step numerical analogue scale and by the physician with 5 questions (5-step scale) adapted from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: A total of 243 patients (166 women, 77 men) with a mean age of 67 years (range 28 - 94) was treated. In the patient's rating, pain at rest as well as in motion decreased significantly from 6.4 +/- 2.1 to 2.9 +/- 2.0 and from 8.1 +/- 1.5 to 4.2 +/- 21, respectively (p < 0.001 for both comparisons). The sum score for the 5 questions with a detailed pain assessment by the physician decreased from 18.8 +/- 3.2 to 11.2 +/- 42 (p < 0.001). A significant pain reduction was also observed for each of the 5 single questions. At the end of observation the proportions of patients with no pain or impairment under different conditions were 5 % (climbing stairs), 14 % (walking), 26 % (standing), 33 % (lying/sitting), and 44 % (sleeping). The most common adverse events were nausea, vomiting, obstipation, and dizziness. Treatment with fentanyl-TTS was usually well-tolerated. CONCLUSION: Severe pain caused by arthrosis can be well treated with fentanyl-TTS with a favourable safety profile.
Subject(s)
Analgesics, Opioid/administration & dosage , Arthralgia/drug therapy , Fentanyl/administration & dosage , Osteoarthritis, Hip/drug therapy , Osteoarthritis, Knee/drug therapy , Administration, Cutaneous , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Delayed-Action Preparations , Female , Fentanyl/adverse effects , Humans , Male , Middle Aged , Pain Measurement , Treatment OutcomeABSTRACT
The German regulations for opioid prescriptions have been changed in February 1998. The regulations have been made much more easier and should therefore have improved the pain management in Germany. We investigated the knowledge of the WHO analgesic ladder and how they have been followed in a nation-wide survey among physicians not specialised in pain management. Only 9% of the questionnaires were returned. Although the majority of the physicians (93%) reported knowledge about the WHO recommendations for the treatment of cancer pain, more than 15% of the participating physicians rated transdermal fentanyl as a weak opioid or even as a non-opioid. A negative pain management index in 15% of the patients gave evidence of poor quality in pain management. The majority of patients (84%) did not receive immediate release analgesics for the treatment of breakthrough pain. Continuous medical education is still necessary before a further alleviation of regulations will help to reduce the undertreatment of patients suffering from cancer pain in Germany.
Subject(s)
Analgesics, Opioid/therapeutic use , Neoplasms/physiopathology , Pain/drug therapy , Aged , Analgesics, Opioid/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug and Narcotic Control/legislation & jurisprudence , Female , Germany , Humans , Male , Middle Aged , Palliative Care , Patient Care Team , Quality Assurance, Health Care , Surveys and Questionnaires , Treatment Outcome , World Health OrganizationABSTRACT
The aim of the presented protocol was to investigate tumour remission and breast conservation rates with and without flap supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. 101 patients with stage IIA-IIIA breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. 96 patients underwent salvage surgery. Complete pathologic response was not related to tumour diameter at diagnosis, the applied chemotherapy regime, number of chemotherapy cycles, overall radiation treatment time and time interval between radiotherapy and surgery. A breast conserving approach was possible in 55 patients (54%). After a median follow-up of 18 months no patient developed an isolated local recurrence.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brachytherapy , Breast Neoplasms/therapy , Hyperthermia, Induced , Iridium Radioisotopes/therapeutic use , Adult , Aged , Breast Neoplasms/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Mastectomy, Segmental , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Remission Induction , Treatment OutcomeABSTRACT
AIM: The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. PATIENTS AND METHODS: One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy 192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 x 2 Gy/week. Local hyperthermia with 43.5-44.5 degrees C over 60 minutes was delivered immediately before interstitial radiotherapy. RESULTS: One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases. CONCLUSION: In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up.
