Assessment of analgesic effects of different initial doses of transdermal buprenorphine in the treatment of chronic pain in the elderly diagnosed with osteoarthritis.

The aim of the study was to evaluate analgesia, adverse effects, and quality of life of elderly patients diagnosed with osteoarthritis during treatment with different initial doses of transdermal buprenorphine. Transdermal buprenorphine was used for 10 days in 60 patients over 64 years old with chronic pain of severe intensity - Numerical Rating Scale (NRS > 5) caused by degenerative changes in joints. All patients were randomly assigned to 3 groups. A starting dose for the treatment was respectively: 8.75 µg/h, 17.5 µg/h or 35 µg/h, in each group. The severity and impact of pain on everyday activities performed by the patients were assessed at baseline and daily for 10 days using the Brief Pain Inventory - Short Form. In order to identify the components of neuropathic pain, except for the symptoms (hyperalgesia and allodynia), the DN4 (Douleur Neuropathique en 4 questionnaire) was used. During buprenorphine treatment a decrease in pain severity was obtained in all groups of patients as well as an improvement in pain interference with general activity, mood, walking ability, relations with other people, sleep and enjoyment of life with no differences between patient groups treated with different initial doses of transdermal buprenorphine. No differences regarding DN4 scores were find between patient groups. Several adverse effects (drowsiness, confusion, vomiting) occurred less frequently in groups of patients treated with lower initial doses (8.75 µg/h and 17.5 µg/h) in comparison to a starting dose of 35 µg/h. We concluded that treatment of elderly patients with chronic pain of severe intensity with transdermal buprenorphine provided effective analgesia and improvement of quality of life with respect to general functioning of patients. Treatment tolerance seemed to be better with lower initial doses of transdermal buprenorphine: 8.75 µg/h and 17.5 µg/h in comparison with the dose of 35 µg/h.

Pathophysiology and clinical characteristics of pain in most common locations in cancer patients.

Pain is one of the most common symptoms in cancer patients, especially in advanced disease. However, pain also accompanies a significant percentage of patients during diagnostic and therapeutic procedures. In some patients pain may be the first symptom of the disease. The causes of pain in cancer patients are often multifactorial including direct and indirect cancer effects, anticancer therapy and co-morbidities. Moreover, pain in cancer patients often has mixed pathophysiology including both nociceptive and neuropathic components, especially in patients with bone metastases. In this article, basic knowledge regarding epidemiology, pathophysiology and clinical features of pain in cancer patients with a primary tumour localised in lung, gastrointestinal tract (stomach, colon and pancreas), breast in women and prostate in men are presented. Pain is a common symptom in cancer patients and its appropriate assessment and treatment may significantly improve in patients' and families' quality of life.

The impact of tramadol and dihydrocodeine treatment on quality of life of patients with cancer pain.

BACKGROUND: Tramadol and dihydrocodeine (DHC) are analgesics of step 2 WHO analgesic ladder (opioids for mild to moderate pain, weak opioids) frequently used in the treatment of cancer pain of moderate intensity. The aim of the study was to assess the impact of tramadol and DHC treatment on quality of life (QL) and performance status (PS) of patients with cancer pain. PATIENTS AND METHODS: Randomised, cross-over, clinical study of 40 opioid-naive patients with nociceptive cancer pain who received tramadol or DHC controlled release tablets for 7 days, and then drugs were switched and administered for another 7 days. Pain was assessed by visual analogue scale (VAS), QL by EORTC QLQ C 30, and PS by Eastern Cooperative Oncology Group (ECOG) and Karnofsky. RESULTS: From 40 patients recruited, 30 completed the study. DHC treatment provided better analgesia (VAS). In QL functional scales, better emotional functioning in tramadol group and better global QL and cognitive functioning in DHC group were observed. In symptom scales, less fatigue, pain and sleep disturbances, less nausea and vomiting and better appetite in DHC group were noted. In tramadol group, less constipation and less financial problems were observed. No differences in dyspnoea and diarrhoea were noted. ECOG and Karnofsky PS were low and did not differ between tramadol and DHC groups. CONCLUSIONS: Dihydrocodeine treatment was associated with better global QL, cognitive functioning, analgesia and appetite, less fatigue, sleep disturbances, nausea and vomiting. Tramadol therapy was connected with better emotional functioning, less constipation and financial problems. PS deteriorated in both tramadol and DHC groups.

The role of methadone in cancer pain treatment--a review.

BACKGROUND: Methadone is an opioid analgesic of step 3 of the World Health Organization (WHO) analgesic ladder. AIM AND METHODS: To outline pharmacodynamics, pharmacokinetics, drug interactions, equianalgesic dose ratio with other opioids, dosing rules, adverse effects and methadone clinical studies in patients with cancer pain. A review of relevant literature on methadone use in cancer pain was conducted. RESULTS: Methadone is used in opioid rotation and administered to patients with cancer pain not responsive to morphine or other strong opioids when intractable opioid adverse effects appear. Methadone is considered as the first strong opioid analgesic and in patients with renal impairment. Methadone possesses different pharmacodynamics and pharmacokinetics in comparison to other opioids. The advantages of methadone include multimode analgesic activity, high oral and rectal bioavailability, long lasting analgesia, lack of active metabolites, excretion mainly with faeces, low cost and a weak immunosuppressive effect. The disadvantages include long and changeable plasma half-life, high bound to serum proteins, metabolism through P450 system, numerous drug interactions, lack of clear equianalgesic dose ratio to other opioids, QT interval prolongation, local reactions when administered subcutaneously. CONCLUSIONS: Methadone is an important opioid analgesic at step 3 of the WHO analgesic ladder. Future controlled studies may focus on establishment of methadone equianalgesic dose ratio with other opioids and its role as the first strong opioid in comparative studies with analgesia, adverse effects and quality of life taken into consideration.

Assessment of quality of life, pain and effectiveness of treatment in palliative care patients.

PURPOSE: Evaluation of quality of life, appraisal of pain quality and intensity, assessment of treatment and care effectiveness in palliative care patients treated at the in-patient Palliative Care Department in Czestochowa Province Hospital. MATERIAL AND METHODS: The study was performed in 50 randomly chosen patients at the in-patient Palliative Care Department in Czestochowa Province Hospital. The studied group comprised 22 women and 28 men. The trial lasted since October 2003 till April 2004 and this was longitudinal study. At the first assessment patients filled Modified Sheet Pain Assessment, Support Team Assessment Schedule (STAS) and Rotterdam Symptom Checklist (RSCL). At the second, third and fourth appraisal patients filled RSCL and STAS. RESULTS: In patients surveyed by STAS at the second assessment 52% of patients achieved very high scores (poor effectiveness of treatment and care), 32% high scores - unsatisfactory treatment and care, 15% average results (average treatment and care). Results of RSCL indicate for decrease in physical activity and global quality of life of terminal patients. At the fourth assessment after 4 weeks of the treatment nearly 80% patients assessed their physical state as low. CONCLUSIONS: The results indicate that patients have poor performance status, no effective treatment is provided, psychological state is significantly impaired, and patients were forced to resign from social life because of cancer progression.

[Research from the Palliative Care Department in Poznan on treatment of neoplasm pain with Durogesic (transdermal fentanyl)]. / Doswiadczenia Kliniki Opieki Paliatywnej w Poznaniu w leczeniu bólu nowotworowego preparatem Durogesic (przezskórny fentanyl).

Transdermal Fentanyl (TF, Durogesic) is a strong opioid analgesic which is used in the treatment of cancer pain. In this article we described basic properties and dosing guidelines for TF and our own experience with use of Durogesic in the treatment of cancer pain. In this open study TF was administered in 16 pts aged of 30-88 (mean 62 +/- 17) years with advanced cancer who suffered from strong cancer pain and who had previously been treated with morphine (11 pts), buprenorphine (1 pt), tramadol (2 pts) and non-opioid analgesics (2 pts). Analgesic efficacy and side-effects of TF were appraised. The time of the treatment was 7-235 (mean 77 +/- 58) days, the dose range 25-600 (mean 129 +/- 117) micrograms/h. The mean initial dose of Durogesic was 94 +/- 99 micrograms/h and the final dose of fentanyl patch was 156 +/- 149 micrograms/h. Good analgesic effect was achieved in 11 pts (69%), partial effect in 2 pts (12%), unsatisfactory analgesia in 3 pts (19%). The treatment was well tolerated and the most frequent adverse reactions were constipation in 10 pts (63%) and drowsiness in 4 pts (25%). During the therapy with TF we didn't encounter serious side-effects which would cause cessation of the treatment. Results of our study confirmed that TF was an effective analgesic most commonly used in pts with stable nociceptive pain especially when opioid analgesics could not be administered orally.