[Opioids for chronic pain patients. What are the consequences of following the Nordic recommendations?]. / Opioider til kroniske smertepatienter. Hvad er konsekvenserne af at følge de nordiske anbefalinger?

INTRODUCTION: In this study the consequences of following the Nordic recommendation for treating chronic pain patients with opioids are illustrated with regard to how many patients started and how many ended opioid treatment, what was the success rate for going from short-acting to long-acting opioids and what were the consequences for the daily doses of going from short-acting to long-acting opioids. MATERIALS AND METHODS: During the study period patients revisited the Pain Centre 6 months after treatment had ended. It was documented whether each patient was treated with opioids initially as well as any changes in the opioid prescription during their treatment. RESULTS: 2/3 of the patients were initially in opioid treatment, 1 patient began while 25% were weaned off opioids during treatment. 88% percent of the patients initially on opioids were changed from short-acting to long-acting opioids. The number of patients who had their opioid doses increased with this change was approximately the same as the number of patients who had their doses reduced and the percent of changes was almost identical. CONCLUSION: Following the Nordic recommendations for treating chronic pain patients with opioids can help to minimise the number of opioid users. The recommendation for going from short-acting to long-acting opioids can be accomplished in daily routine and in this study there is no indication that changing from short-acting to long-acting opioids per se increases daily doses.

[Methadone in the treatment of chronic non-malignant pain]. / Metadon til behandling af kroniske ikkemaligne smerter.

INTRODUCTION: The use of methadone may be difficult and its use in the treatment of chronic non-malignant pain is only sparsely described in literature, whereas several works have shown the advantage of methadone in the treatment of cancer pain. The aim of this analysis is to assess the advantages and disadvantages of methadone in the treatment of chronic pain and to evaluate the method used in The Pain Centre of the Funen Region when initiating treatment. MATERIALS AND METHOD: The analysis is retrospective and includes 83 patients in an ambulatory setting with chronic pain who were treated with methadone either as the primary choice of opioid or by rotation with another opioid using a rotation ratio of 10:1 (morphine:methadone) initially and subsequently titrating to maximum effect with fewest adverse events. RESULTS: Among rotated patients 59% had good pain relief on methadone with a daily dose of 20.5 (1.5-82.5) mg: the frequency for dropping methadone because of adverse events was 24% and 17% because of lack of effect. Among opioid-naive 12% had good pain relief. The daily dose was 3.75 (3.5-4) mg. Here adverse events caused 76% of the cases to discontinue and a lack of effect caused 12% to discontinue. CONCLUSION: Opioid treated chronic pain patients with insufficient pain relief may benefit from conversion to methadone, as 59% in our analysis achieved better pain relief, while the rotation was generally opioid-saving at the same time. The method used was safe and acceptable to the patients. The analyses did not result in any fundamental changes to the procedure.