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505 DURATION OF TREATMENT RESPONSE TO QUTENZA (TM) (NGX-4010), A HIGH-CONCENTRATION CAPSAICIN PATCH, IN PATIENTS WITH POSTHERPETIC NEURALGIA
Posters / European Journal of Pain Supplements 4 (2010) 47–146
504 CHANGE PAIN SURVEY AT EFIC 2009 – PHYSICIAN’S PERCEPTION ON MANAGEMENT OF SEVERE CHRONIC NON-CANCER PAIN G. Varrassi1 , S. Nossol2 , S. Wiemer2 . 1 EFIC, Vilvoorde, Belgium; 2 Gr¨ unenthal, GmbH, Aachen, Germany Introduction: Successful management of severe chronic pain, especially when neuropathic components are involved, requires good understanding of the underlying pathophysiology and pharmacological characteristics of analgesics. Objectives: Obtain insight into physician’s understanding of severe chronic pain, current treatment behaviour, and experience with classical strong opioids. Methods: At the EFIC congress 2009, visitors were invited to answer questions on severe chronic non-cancer pain via touch screen computers at the Grunenthal ¨ booth. For this abstract answers to those questions with special focus on pain with neuropathic components are analysed descriptively. Results: Of 3.384 delegates 403 completed the survey (54% anaesthesiologists/pain specialists). On a 5-point scale (1 = I do not agree, 5 = I totally agree), 88%* stated there is limited awareness on physiological differences between neuropathic and nociceptive pain in the medical community and 91%* perceived a lack of knowledge on pharmacological characteristics of different analgesics. Pain with a neuropathic component is often more severe and more difficult to treat stated 96%* and 94%* agreed that in severe chronic LBP the neuropathic component is often not clearly diagnosed. 93% use combination therapy as pharmacological treatment approach for severe chronic LBP, including 104 different combinations. Physicians who never prescribe opioids for severe chronic non-cancer pain (19%) perceive tolerance development to be a main reason limiting treatment success, whereas opioid-experienced prescribers (13%) name nausea and vomiting. Conclusion: The survey confirmed a lack of knowledge for treatment of pain with neuropathic components and showed the variety of treatment approaches currently applied. *Ratings ≥3. 505 DURATION OF TREATMENT RESPONSE TO QUTENZA (TM) (NGX-4010), A HIGH-CONCENTRATION CAPSAICIN PATCH, IN PATIENTS WITH POSTHERPETIC NEURALGIA L. Webster1 , T.P. Malan2 , M.M. Tuchman3 , M.D. Mollen4 , J.K. Tobias5 , B. Lu5 , G.F. Vanhove5 . 1 Lifetree Clinical Research and Pain Clinic, Lifetree Medical, Inc., Salt Lake City, UT, 2 Department of Anesthesiology, University of Arizona, Tucson, AZ, 3 Palm Beach Neurological Center, Palm Beach Gardens, FL, 4 Arizona Research Center, Phoenix, AZ, 5 NeurogesX, Inc., San Mateo, CA, USA Introduction: Qutenza is a high-concentration capsaicin patch (8%) indicated in Europe to treat peripheral neuropathic pain in nondiabetic adults. Objectives: To evaluate response duration of Qutenza. Methods: In a two-phase PHN study, patients randomized in the double-blind, controlled phase to Qutenza or a low-concentration capsaicin (0.04%) control patch for 30, 60, or 90 minutes could receive up to 3 additional 60-minute Qutenza treatments at least 12 weeks apart in the open-label extension phase. Response duration (RD), defined as the number of weeks between the first (double-label) Qutenza treatment and relapse, was evaluated for patients with a ≥30% pain reduction for 2 consecutive weeks occurring within 6 weeks after their first Qutenza treatment. Relapse was defined as two consecutive weekly pain reductions of <20% or one pain reduction of <20% followed by study dropout. The effect of age, PHN duration, baseline pain score, treatment area, maximum pain increase on the treatment day, gender, pain reduction at week 2 and concomitant neuropathic pain medication use on RD were explored. Results: 282 patients received Qutenza and 123 (44%) responded. Median RD was 22 weeks. 17 patients (14%) responded for more
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than 40 weeks and 10 (8%) became and remained pain free. Patients with lower baseline pain scores (<5), shorter PHN duration (<3.5 years) and greater pain reduction at week 2 (≥40%) were more likely to have longer responses. No other parameters affected RD. Conclusions: These results suggest that Qutenza can provide prolonged pain relief following a single administration. 506 PHARMACOEPIDEMIOLOGY OF NEUROPATHIC PAIN (NP) PATIENTS REFERRED TO A TERTIARY CARE PAIN CLINIC B. Yegneswaran1 , A.F. Louffat2 , S.F. Lakha2,3 , A. Mailis-Gagnon2,4,5 . 1 Internal Medicine, Drexel University College of Medicine/St Peter’s University Hospital, New Brunswick, NJ, USA; 2 Comprehensive Pain Program, Toronto Western Hospital, 3 Institue of Medical Sciences, University of Toronto, 4 University of Toronto, Center for the Study of Pain, 5 Krembil Neuroscience Center, Toronto, ON, Canada Introduction: Previous research has shown that NP is treated rather poorly in the community. Objective: To describe the demographics and prescription drugs of NP patients entering a tertiary pain clinic. Methods: Cross-sectional study of 119 consecutive NP patients was done over one year period. Detailed demographics, pain ratings and drug doses (as prescribed by their treating physicians) were obtained. High Opioid Users (HOU) received more than 200 mg of morphine equivalents daily. Results: Female/male ratio was 1/1, mean age 48.5 yrs (range 11–80); 30% of the patients had some employment, 48% were unemployed and 14% retirees. Average pain ratings were 6.4±1.9 in a 0–10 numerical rating scale. The commonest NP syndromes were NP due to multiple injuries, chronic lumbar and cervical radiculopathy, traumatic nerve injury, spinal cord injury, peripheral neuropathies including diabetic neuropathy and CRPS I. Coexisting musculoskeletal pathology was found in 30.5% of the women and 7% of men. Opioids were prescribed in 58% of the patients: 47.5% of the females (all below 200 ME), and 68% of males (1/3 of whom were HOU). Oxycodone preparations were by far the commonest opioid prescribed. Antiepileptics (AEs) were prescribed in 34%, Tricyclic Antidepressants (TCAs) in 14%, benzodiazepines in 21% and NSAIDs in 23.5% of the patients. Pregabalin was the commonest prescribed AE followed by gabapentin. Conclusions: The study shows that a subgroup of NP community patients who require referral to a tertiary pain clinic for management of moderate/severe pain, is more likely to receive opioids than AEs and TCAs. 507 EPIDURAL ANALGESIA PLUS PREGABALIN IMPROVES QUALITY OF LIFE IN CHRONIC NEUROPATHIC PAIN PATIENTS P. Arambatzis1 , C. Pourzitaki2 , E. Haftoura1 , E. Toutounopoulou1 , D. Kouvelas2 . 1 Anaesthesiology, Achillopouleion General Hospital, Volos, 2 Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessalon´ıki, Greece Introduction: Chronic neuropathic pain is often the result of a mixture of pain mechanisms, and therefore is difficult to manage. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has demonstrated efficacy in the management of chronic pain. Objectives: The aim of our research was to investigate the quality of life improvement in patients suffering from chronic neuropathic pain, under pregabalin treatment following epidural analgesia. Methods: Our research was conducted in accordance to Helsinki declarations and ethical guidelines for pain research in humans. Twenty four adult patients, ASA < IV with chronic neuropathic pain were included in our study. Patients were treated in our Pain Outpatient’s Department with continuous epidural analgesia using ropivacaine and 24 hours later were administered pregabalin 150 mg daily for 30 days. The quality of life test Euroquol and VAS score were used 1 day after epidural analgesia and 1, 14 and 30 days
504 CHANGE PAIN SURVEY AT EFIC 2009 – PHYSICIAN’S PERCEPTION ON MANAGEMENT OF SEVERE CHRONIC NON-CANCER PAIN G. Varrassi1 , S. Nossol2 , S. Wiemer2 . 1 EFIC, Vilvoorde, Belgium; 2 Gr¨ unenthal, GmbH, Aachen, Germany Introduction: Successful management of severe chronic pain, especially when neuropathic components are involved, requires good understanding of the underlying pathophysiology and pharmacological characteristics of analgesics. Objectives: Obtain insight into physician’s understanding of severe chronic pain, current treatment behaviour, and experience with classical strong opioids. Methods: At the EFIC congress 2009, visitors were invited to answer questions on severe chronic non-cancer pain via touch screen computers at the Grunenthal ¨ booth. For this abstract answers to those questions with special focus on pain with neuropathic components are analysed descriptively. Results: Of 3.384 delegates 403 completed the survey (54% anaesthesiologists/pain specialists). On a 5-point scale (1 = I do not agree, 5 = I totally agree), 88%* stated there is limited awareness on physiological differences between neuropathic and nociceptive pain in the medical community and 91%* perceived a lack of knowledge on pharmacological characteristics of different analgesics. Pain with a neuropathic component is often more severe and more difficult to treat stated 96%* and 94%* agreed that in severe chronic LBP the neuropathic component is often not clearly diagnosed. 93% use combination therapy as pharmacological treatment approach for severe chronic LBP, including 104 different combinations. Physicians who never prescribe opioids for severe chronic non-cancer pain (19%) perceive tolerance development to be a main reason limiting treatment success, whereas opioid-experienced prescribers (13%) name nausea and vomiting. Conclusion: The survey confirmed a lack of knowledge for treatment of pain with neuropathic components and showed the variety of treatment approaches currently applied. *Ratings ≥3. 505 DURATION OF TREATMENT RESPONSE TO QUTENZA (TM) (NGX-4010), A HIGH-CONCENTRATION CAPSAICIN PATCH, IN PATIENTS WITH POSTHERPETIC NEURALGIA L. Webster1 , T.P. Malan2 , M.M. Tuchman3 , M.D. Mollen4 , J.K. Tobias5 , B. Lu5 , G.F. Vanhove5 . 1 Lifetree Clinical Research and Pain Clinic, Lifetree Medical, Inc., Salt Lake City, UT, 2 Department of Anesthesiology, University of Arizona, Tucson, AZ, 3 Palm Beach Neurological Center, Palm Beach Gardens, FL, 4 Arizona Research Center, Phoenix, AZ, 5 NeurogesX, Inc., San Mateo, CA, USA Introduction: Qutenza is a high-concentration capsaicin patch (8%) indicated in Europe to treat peripheral neuropathic pain in nondiabetic adults. Objectives: To evaluate response duration of Qutenza. Methods: In a two-phase PHN study, patients randomized in the double-blind, controlled phase to Qutenza or a low-concentration capsaicin (0.04%) control patch for 30, 60, or 90 minutes could receive up to 3 additional 60-minute Qutenza treatments at least 12 weeks apart in the open-label extension phase. Response duration (RD), defined as the number of weeks between the first (double-label) Qutenza treatment and relapse, was evaluated for patients with a ≥30% pain reduction for 2 consecutive weeks occurring within 6 weeks after their first Qutenza treatment. Relapse was defined as two consecutive weekly pain reductions of <20% or one pain reduction of <20% followed by study dropout. The effect of age, PHN duration, baseline pain score, treatment area, maximum pain increase on the treatment day, gender, pain reduction at week 2 and concomitant neuropathic pain medication use on RD were explored. Results: 282 patients received Qutenza and 123 (44%) responded. Median RD was 22 weeks. 17 patients (14%) responded for more
143
than 40 weeks and 10 (8%) became and remained pain free. Patients with lower baseline pain scores (<5), shorter PHN duration (<3.5 years) and greater pain reduction at week 2 (≥40%) were more likely to have longer responses. No other parameters affected RD. Conclusions: These results suggest that Qutenza can provide prolonged pain relief following a single administration. 506 PHARMACOEPIDEMIOLOGY OF NEUROPATHIC PAIN (NP) PATIENTS REFERRED TO A TERTIARY CARE PAIN CLINIC B. Yegneswaran1 , A.F. Louffat2 , S.F. Lakha2,3 , A. Mailis-Gagnon2,4,5 . 1 Internal Medicine, Drexel University College of Medicine/St Peter’s University Hospital, New Brunswick, NJ, USA; 2 Comprehensive Pain Program, Toronto Western Hospital, 3 Institue of Medical Sciences, University of Toronto, 4 University of Toronto, Center for the Study of Pain, 5 Krembil Neuroscience Center, Toronto, ON, Canada Introduction: Previous research has shown that NP is treated rather poorly in the community. Objective: To describe the demographics and prescription drugs of NP patients entering a tertiary pain clinic. Methods: Cross-sectional study of 119 consecutive NP patients was done over one year period. Detailed demographics, pain ratings and drug doses (as prescribed by their treating physicians) were obtained. High Opioid Users (HOU) received more than 200 mg of morphine equivalents daily. Results: Female/male ratio was 1/1, mean age 48.5 yrs (range 11–80); 30% of the patients had some employment, 48% were unemployed and 14% retirees. Average pain ratings were 6.4±1.9 in a 0–10 numerical rating scale. The commonest NP syndromes were NP due to multiple injuries, chronic lumbar and cervical radiculopathy, traumatic nerve injury, spinal cord injury, peripheral neuropathies including diabetic neuropathy and CRPS I. Coexisting musculoskeletal pathology was found in 30.5% of the women and 7% of men. Opioids were prescribed in 58% of the patients: 47.5% of the females (all below 200 ME), and 68% of males (1/3 of whom were HOU). Oxycodone preparations were by far the commonest opioid prescribed. Antiepileptics (AEs) were prescribed in 34%, Tricyclic Antidepressants (TCAs) in 14%, benzodiazepines in 21% and NSAIDs in 23.5% of the patients. Pregabalin was the commonest prescribed AE followed by gabapentin. Conclusions: The study shows that a subgroup of NP community patients who require referral to a tertiary pain clinic for management of moderate/severe pain, is more likely to receive opioids than AEs and TCAs. 507 EPIDURAL ANALGESIA PLUS PREGABALIN IMPROVES QUALITY OF LIFE IN CHRONIC NEUROPATHIC PAIN PATIENTS P. Arambatzis1 , C. Pourzitaki2 , E. Haftoura1 , E. Toutounopoulou1 , D. Kouvelas2 . 1 Anaesthesiology, Achillopouleion General Hospital, Volos, 2 Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessalon´ıki, Greece Introduction: Chronic neuropathic pain is often the result of a mixture of pain mechanisms, and therefore is difficult to manage. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has demonstrated efficacy in the management of chronic pain. Objectives: The aim of our research was to investigate the quality of life improvement in patients suffering from chronic neuropathic pain, under pregabalin treatment following epidural analgesia. Methods: Our research was conducted in accordance to Helsinki declarations and ethical guidelines for pain research in humans. Twenty four adult patients, ASA < IV with chronic neuropathic pain were included in our study. Patients were treated in our Pain Outpatient’s Department with continuous epidural analgesia using ropivacaine and 24 hours later were administered pregabalin 150 mg daily for 30 days. The quality of life test Euroquol and VAS score were used 1 day after epidural analgesia and 1, 14 and 30 days