- Email: [email protected]
439 CORRELATION OF NUMERIC RATING SCALE (NRS), NEUROPATHIC PAIN QUESTIONNAIRE (NPQ), AND KEYWORDS IN STUDY FOR TREATING NEUROPATHIC PAIN WITH KRN5500
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Posters / European Journal of Pain Supplements 4 (2010) 47–146
as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment but frozen shoulder patients showed significant difference between three groups. Conclusions: Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome. 436 NEUROPATHIC PAIN IN CANCER PATIENTS – PREVALENCE AND MANAGEMENT IN TERTIARY CARE CENTER OF INDIA S. Bhatnagar, S. Mishra, S. Roshini, V. Gogia. Anaesthesia, IRCH, AIIMS, New Delhi, India Introduction: Cancer pain is often intractable and has a considerable impact on the quality of life. Nociceptive pain is recognized easily and managed using conventional analgesics. The neuropathic component makes cancer pain difficult to manage. The epidemiology of neuropathic pain in cancer patients has not been well documented. Objective: This retrospective study attempts to discern the prevalence of neuropathic pain in cancer patients referred to pain and palliative care clinic over a period of two years at tertiary care cancer center in India. The study also aims to describe approach to neuropathic cancer pain alleviation. Materials and methods: A retrospective analysis of 3238 cancer patients who presented with complaints of pain during the period 2006–2008 was done. Findings including type and intensity of pain, initial evaluation, treatment initiated and other associated symptoms were recorded at the initial visit and at one week, one month and six months thereafter. Pain with a burning, radiating or shooting component was considered to be neuropathic. Results: The prevalence of neuropathic pain in cancer pain patients, was found to be 11.8%. While oral morphine emerged the commonest cancer pain management modality (95.8% of patients) with adjuvants. However, 29.89% of our patients with neuropathic pain required interventional blocks for adequate pain relief. Conclusion: The present study highlights the significance of neuropathic pain as an integral component of cancer pain and further provides an insight into its management. 437 INTRATHECAL ZICONOTIDE FOR MALIGNANT PAIN IN A PATIENT WITH SQUAMOUS CELL CARCINOMA OF THE OESOPHAGUS WITH SIDE EFFECTS TO OPIOIDS M. Brookes, S. Eldabe. Pain Clinic, James Cook University Hospital, Middlesbrough, UK Introduction: Ziconotide is a non-opioid intrathecal (IT) analgesia for patients with severe chronic pain who are refractory to other treatments. Objectives: To assess the efficacy of ziconotide in a patient with malignant pain. Methods: A 59 year-old female with squamous cell carcinoma of the oesophagus, with a single metastatic lesion in the right acetabulum, was referred for IT analgesia. The patient had received oral opioids, which provided good analgesia, but excessive side effects. The patient complained of a dull aching pain in the right hip, which was moderate at rest and severe on mobilization (VAS = 8–9/10). Results: As oral opioids were effective, it was decided to proceed to an implant of a Synchromed® (Medtronic) programmable pump infused with morphine/bupivacaine. Following a priming bolus, the patient was initiated on morphine (0.5 mg/day)/ bupivacaine (2 mg/day). At 48 hrs, no pain improvement or side effects were observed. Morphine/bupivacaine was increased to 0.75 mg/day/3 mg/day, then 1 mg/day/4 mg/day over a 3-day period.
Pain was controlled but accompanied by severe nausea and vomiting for 3 days, which was not alleviated by insertion of a stent. The patient switched to ziconotide. Following a priming bolus, delivery started at 2.4 mcg/day increasing to 3.6 mcg/day on day 3. Nausea and vomiting cleared, and pain control improved as the ziconotide dose gradually increased to 6.8 mcg/day over 2 weeks (VAS = 3–4/10). The patient died with good pain control 2 months later. Conclusions: Persistent side effects to opioids were managed when the patient was switched to ziconotide, with good pain control and minimal side effects. 438 PREVALENCE AND FEATURES OF NEUROPATHIC PAIN IN PATIENTS WITH NEWLY DIAGNOSED PRIMARY BREAST CANCER J. Bruce1 , A. Thornton1 , S. Marfizo2 , N. Scott3 , A. Thompson4 , S. Heys5 , Recovery Study Group. 1 Epidemiology Group, University of Aberdeen, Aberdeen, 2 University of Dundee, Dundee, 3 Population Health, University of Aberdeen, Aberdeen, 4 Surgery, University of Dundee, Dundee, 5 Surgery, University of Aberdeen, Aberdeen, UK Introduction: Chronic pain is common after surgery with rates of up to 40% after breast cancer surgery. Persistent postoperative pain is predominantly, but not always, neuropathic in character [1]. Patients are broadly subjected to a similar surgical insult but mechanisms and processes contributing to pain onset may vary. Less is known about prevalence, features and distribution of pain pre-operatively, particularly whether patients have existing neuropathic symptoms before surgery. Objectives: To investigate the prevalence, features and location of pre-operative neuropathic pain in women undergoing surgery for primary breast cancer. Methods: A prospective observational cohort study recruiting from four breast cancer units in North Scotland (300 patients recruited to date). Newly diagnosed women with histologically proven primary invasive or non-invasive breast cancer requiring surgical treatment are being invited to participate. Assessment of pain intensity, location and character is conducted using body maps, the DN4, S-LANSS and MPQ standardised questionnaires administered before surgery and four and nine months postoperatively. Other comorbidity and previous/existing chronic pain conditions are being recorded. Results: Preliminary analysis of the first 100 recruited patients, mean age 61 years (SD 10.1), 64% married, revealed that almost half (46%) reported having ache, pain, altered sensations or numbness in the upper body preoperatively. Of these, 15% of women were classified as having neuropathic pain using the DN4 (score ≥3) with 6/45 (13%) being S-LANSS positive (score ≥12). Presence and features of upper body neuropathic pain will be fully presented within the poster. Reference(s) [1] Kehlet H et al. (2006). Lancet, 367(9522), 1618–25.
439 CORRELATION OF NUMERIC RATING SCALE (NRS), NEUROPATHIC PAIN QUESTIONNAIRE (NPQ), AND KEYWORDS IN STUDY FOR TREATING NEUROPATHIC PAIN WITH KRN5500. L. Jett1 , S. Spruill2 , I. Pike3 . 1 Research & Development, DARA BioSciences, Raleigh, 2 Applied Statistics and Consulting, Spruce Pine, NC, 3 Izzy Pike MD Consulting, Fairhope, AL, USA Introduction: Patients use keywords like “burning” to describe neuropathic pain (NP). But little has been reported on the correlation between patient descriptions and quantitative measures of pain. Objectives: Study DTCL100 was a proof of concept study to evaluate the effects of KRN5500 in reducing NP. Methods: DTCL100 was a multicenter, placebo-controlled, randomized study in patients with end-stage cancer experiencing
Posters / European Journal of Pain Supplements 4 (2010) 47–146
NP. During each study visit, patients rated their pain on a 0–10 point NRS and on the 0–100 point NPQ items. They also described their pain in their own words. NRS and NPQ symptom scores were summarized for the best overall response. A Wilcoxon Rank Sum test was used to assess treatment differences. Results: Twelve (12) of 19 patients received KRN5500. Baseline characteristics were consistent between the KRN5500 and Placebo treatment groups. Patients described their pain as: tingling (37%), numb (32%), burning (16%), shooting (16%), electric (11%) and freezing (5%). The correlations between baseline NRS and symptoms were significant for burning (r = 0.56) and freezing (r = 0.58). The correlation between post-treatment NRS and NPQ symptoms were significant for electric (r = 0.50), “sensitive to touch” (r = 0.58), shooting (r = 0.56) and tingling (r = 0.55). However, no treatment differences in symptoms were observed. KRN5500 treated patients showed a median decrease of 29.3% in NRS in while placebo treated patients showed no decrease (p = 0.02). Conclusions: Patient descriptions of pain were consistent with symptoms in the NPQ. While the NPQ scores appeared to be positively correlated with NRS, the symptom scoring methods were not sensitive enough to detect the efficacy of KRN5500 in this study. 440 PANCOAST TUMOR PRESENTING WITH ARM PAIN F. Koc1 , H. Bozdemir1 , S. Paydas2 . 1 Neurology, 2 Oncology, Cukurova University, Adana, Turkey Introduction: Although trauma is the main cause of the plexopathies, it may be seen by the tumoral invasion as well. Pulmonar apex tumors named Pancoast may lead to pain of the arm due to brachial plexus lower truncus invasion. Objectives: We presented 2 male patients with Pancoast tumor which first presentation was pain of the arm. Results: 45 years old male patient with the 3 months of complaint of severe right shoulder pain which is ranging to the upper arm and irresponsive to analgesics admitted to the clinic. Horner Syndrome at the right eye has been determined in neurological examination. The radiologic investigations showed tumor at the pulmonary apex at the right. Servical MRI has demonstrated a mass lesion located centerally at the right anterior mediastenum extending to lower servical levels and thereby invading plexus. 55 years old male patient with severe pain at the left arm which is irresponsive to analgesics admitted to the clinic. He reported right arm pain beginning approximatley 1 year ago and along the way syptoms of fatigue, weight loss and cough added, eventually he had a diagnosis of small cell pulmonary cancer. There were no further investigation regarding pain of the arm although it was the first symptom. Horner Syndrome at the right eye, right monoparesis at the level of 3-/5 has been observed in neurological examination. Servical MRI demonstrated brachial plexus invasion. Conclusions: Patients presenting with the pain of arm should be taken cautiously because of the pulmonary cancer and similar pathology possibility.
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medication such as antidepressants, anticonvulsants and local anesthetics were administered based on pain category (nociceptive, neuropathic or both) as well as particular characteristics. Results: Pain was mostly due to the cancer itself throughout the entire follow up. Approximately 80% of patients with head and neck cancer experience exclusively nociceptive pain and 24% experience both nociceptive and neuropathic pain. The presence of neuropathic pain was directly associated with the nerve destruction following radical neck dissection (P-value<0.001). Analgesic medication based on the WHO’s 3 step ladder. Pain intensity was greatly reduced within a week of treatment. The difference between the pain score at the beginning and the median score throughout the study, was statistically significant lower (P-value<0.001). Other symptoms like insomnia, anorexia, constipation were also statistically significantly (P-value<0.001) improved. Symptoms such as sweats, shortness of breath and nausea were transient and easily treated. Conclusions: Head and neck cancer patients experience pain in the final stages of their disease. The administration of analgesic and adjuvant medication according etiology, based on WHO’s three step analgesic ladder results in the resolution of pain. 442 THE ROLE OF KETAMINE IN THE MANAGEMENT OF NEUROPATHIC CANCER PAIN – A POLISH EXPERIENCE W. Leppert. Chair and Department of Palliative Medicine, Poznan University of Medicial Sciences, Poznan, Poland Objective: To assess analgesic efficacy and adverse effects of ketamine in the treatment of neuropathic cancer pain. Patients and methods: A retrospective evaluation of 30 patients with severe cancer neuropathic pain, which did not respond to opioid therapy. All patients were treated at the in-patient palliative medicine unit at the Chair and Department of Palliative Medicine of Poznan University. Ketamine was administered in continuous infusion subcutaneously (11 patients) or intravenously (19 patients). All patients treated with ketamine received also morphine and midazolam. Analgesia was assessed by 11-point NRS (Numerical Rating Scale: 0-no pain, 10-unbearable pain), adverse effects by verbal scale (0-none, 1-weak, 2-moderate, 3-severe). Results: The treatment time was 3–68 (median 31) days, daily doses of ketamine were 20–250 mg (median 84 mg). Good analgesia (NRS < 4) was achieved in 20 (67%), partial effect (NRS 4–5) in 9 (30%), ineffective treatment (NRS > 5) in 1 (3%) patient. No respiratory depression was observed. The tolerance of the therapy was acceptable with most frequent adverse effect reported sedation (12 patients: in 5 mild, in 6 moderate, in 1 severe, which decrease after dose reduction). Five patients experienced mild dizziness and two patients bad dreams. Conclusions: The addition of ketamine to opioid therapy increased significantly analgesic effect comparing to opioids administered alone. A close monitoring, start with low ketamine dose and the addition of midazolam may decrease adverse effects incidence and intensity.
441 PAIN MANAGEMENT BASED ON THE ETIOLOGY AND MECHANISM OF PAIN IN HEAD AND NECK CANCER E. Lampropoulou, A. Makris, V. Dimopoulou, K. Apostolopoulos. Hospital of Kalamata, Kalamata, Greece
443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS A. Vadalouca1 , E. Raptis2 , A. Moutzouri1 , E. Stavropoulou1 , I. Siafaka1 , E. Argyra1 . 1 A’ Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of Athens, 2 Pfizer Hellas, Athens, Greece
Objectives: To examine the causes and mechanisms of pain in Greek patients with he ad and neck cancer and the effectiveness of the World Health Organization (WHO) guidelines for pain management. Methods: Data were collected from 103 patients (73 male, 30 female). Particular pain syndromes were categorized based on pain etiology and mechanism. Treatment was based on the World Health Organization (WHO) “three step analgesic ladder”. Adjuvant
Introduction: Escalation of opioid dose remains a common practice for the management of inadequately controlled cancer pain. Unfortunately, in the case of neuropathic cancer pain, this practice often shows poor analgesic results and/or increased incidence of opioid-related side effects. The role of specific adjuvants has not been adequately investigated. Objectives: To examine whether the addition of pregabalin in neuropathic cancer pain resistant to a combination of opioids, NSAIDs,
Posters / European Journal of Pain Supplements 4 (2010) 47–146
as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment but frozen shoulder patients showed significant difference between three groups. Conclusions: Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome. 436 NEUROPATHIC PAIN IN CANCER PATIENTS – PREVALENCE AND MANAGEMENT IN TERTIARY CARE CENTER OF INDIA S. Bhatnagar, S. Mishra, S. Roshini, V. Gogia. Anaesthesia, IRCH, AIIMS, New Delhi, India Introduction: Cancer pain is often intractable and has a considerable impact on the quality of life. Nociceptive pain is recognized easily and managed using conventional analgesics. The neuropathic component makes cancer pain difficult to manage. The epidemiology of neuropathic pain in cancer patients has not been well documented. Objective: This retrospective study attempts to discern the prevalence of neuropathic pain in cancer patients referred to pain and palliative care clinic over a period of two years at tertiary care cancer center in India. The study also aims to describe approach to neuropathic cancer pain alleviation. Materials and methods: A retrospective analysis of 3238 cancer patients who presented with complaints of pain during the period 2006–2008 was done. Findings including type and intensity of pain, initial evaluation, treatment initiated and other associated symptoms were recorded at the initial visit and at one week, one month and six months thereafter. Pain with a burning, radiating or shooting component was considered to be neuropathic. Results: The prevalence of neuropathic pain in cancer pain patients, was found to be 11.8%. While oral morphine emerged the commonest cancer pain management modality (95.8% of patients) with adjuvants. However, 29.89% of our patients with neuropathic pain required interventional blocks for adequate pain relief. Conclusion: The present study highlights the significance of neuropathic pain as an integral component of cancer pain and further provides an insight into its management. 437 INTRATHECAL ZICONOTIDE FOR MALIGNANT PAIN IN A PATIENT WITH SQUAMOUS CELL CARCINOMA OF THE OESOPHAGUS WITH SIDE EFFECTS TO OPIOIDS M. Brookes, S. Eldabe. Pain Clinic, James Cook University Hospital, Middlesbrough, UK Introduction: Ziconotide is a non-opioid intrathecal (IT) analgesia for patients with severe chronic pain who are refractory to other treatments. Objectives: To assess the efficacy of ziconotide in a patient with malignant pain. Methods: A 59 year-old female with squamous cell carcinoma of the oesophagus, with a single metastatic lesion in the right acetabulum, was referred for IT analgesia. The patient had received oral opioids, which provided good analgesia, but excessive side effects. The patient complained of a dull aching pain in the right hip, which was moderate at rest and severe on mobilization (VAS = 8–9/10). Results: As oral opioids were effective, it was decided to proceed to an implant of a Synchromed® (Medtronic) programmable pump infused with morphine/bupivacaine. Following a priming bolus, the patient was initiated on morphine (0.5 mg/day)/ bupivacaine (2 mg/day). At 48 hrs, no pain improvement or side effects were observed. Morphine/bupivacaine was increased to 0.75 mg/day/3 mg/day, then 1 mg/day/4 mg/day over a 3-day period.
Pain was controlled but accompanied by severe nausea and vomiting for 3 days, which was not alleviated by insertion of a stent. The patient switched to ziconotide. Following a priming bolus, delivery started at 2.4 mcg/day increasing to 3.6 mcg/day on day 3. Nausea and vomiting cleared, and pain control improved as the ziconotide dose gradually increased to 6.8 mcg/day over 2 weeks (VAS = 3–4/10). The patient died with good pain control 2 months later. Conclusions: Persistent side effects to opioids were managed when the patient was switched to ziconotide, with good pain control and minimal side effects. 438 PREVALENCE AND FEATURES OF NEUROPATHIC PAIN IN PATIENTS WITH NEWLY DIAGNOSED PRIMARY BREAST CANCER J. Bruce1 , A. Thornton1 , S. Marfizo2 , N. Scott3 , A. Thompson4 , S. Heys5 , Recovery Study Group. 1 Epidemiology Group, University of Aberdeen, Aberdeen, 2 University of Dundee, Dundee, 3 Population Health, University of Aberdeen, Aberdeen, 4 Surgery, University of Dundee, Dundee, 5 Surgery, University of Aberdeen, Aberdeen, UK Introduction: Chronic pain is common after surgery with rates of up to 40% after breast cancer surgery. Persistent postoperative pain is predominantly, but not always, neuropathic in character [1]. Patients are broadly subjected to a similar surgical insult but mechanisms and processes contributing to pain onset may vary. Less is known about prevalence, features and distribution of pain pre-operatively, particularly whether patients have existing neuropathic symptoms before surgery. Objectives: To investigate the prevalence, features and location of pre-operative neuropathic pain in women undergoing surgery for primary breast cancer. Methods: A prospective observational cohort study recruiting from four breast cancer units in North Scotland (300 patients recruited to date). Newly diagnosed women with histologically proven primary invasive or non-invasive breast cancer requiring surgical treatment are being invited to participate. Assessment of pain intensity, location and character is conducted using body maps, the DN4, S-LANSS and MPQ standardised questionnaires administered before surgery and four and nine months postoperatively. Other comorbidity and previous/existing chronic pain conditions are being recorded. Results: Preliminary analysis of the first 100 recruited patients, mean age 61 years (SD 10.1), 64% married, revealed that almost half (46%) reported having ache, pain, altered sensations or numbness in the upper body preoperatively. Of these, 15% of women were classified as having neuropathic pain using the DN4 (score ≥3) with 6/45 (13%) being S-LANSS positive (score ≥12). Presence and features of upper body neuropathic pain will be fully presented within the poster. Reference(s) [1] Kehlet H et al. (2006). Lancet, 367(9522), 1618–25.
439 CORRELATION OF NUMERIC RATING SCALE (NRS), NEUROPATHIC PAIN QUESTIONNAIRE (NPQ), AND KEYWORDS IN STUDY FOR TREATING NEUROPATHIC PAIN WITH KRN5500. L. Jett1 , S. Spruill2 , I. Pike3 . 1 Research & Development, DARA BioSciences, Raleigh, 2 Applied Statistics and Consulting, Spruce Pine, NC, 3 Izzy Pike MD Consulting, Fairhope, AL, USA Introduction: Patients use keywords like “burning” to describe neuropathic pain (NP). But little has been reported on the correlation between patient descriptions and quantitative measures of pain. Objectives: Study DTCL100 was a proof of concept study to evaluate the effects of KRN5500 in reducing NP. Methods: DTCL100 was a multicenter, placebo-controlled, randomized study in patients with end-stage cancer experiencing
Posters / European Journal of Pain Supplements 4 (2010) 47–146
NP. During each study visit, patients rated their pain on a 0–10 point NRS and on the 0–100 point NPQ items. They also described their pain in their own words. NRS and NPQ symptom scores were summarized for the best overall response. A Wilcoxon Rank Sum test was used to assess treatment differences. Results: Twelve (12) of 19 patients received KRN5500. Baseline characteristics were consistent between the KRN5500 and Placebo treatment groups. Patients described their pain as: tingling (37%), numb (32%), burning (16%), shooting (16%), electric (11%) and freezing (5%). The correlations between baseline NRS and symptoms were significant for burning (r = 0.56) and freezing (r = 0.58). The correlation between post-treatment NRS and NPQ symptoms were significant for electric (r = 0.50), “sensitive to touch” (r = 0.58), shooting (r = 0.56) and tingling (r = 0.55). However, no treatment differences in symptoms were observed. KRN5500 treated patients showed a median decrease of 29.3% in NRS in while placebo treated patients showed no decrease (p = 0.02). Conclusions: Patient descriptions of pain were consistent with symptoms in the NPQ. While the NPQ scores appeared to be positively correlated with NRS, the symptom scoring methods were not sensitive enough to detect the efficacy of KRN5500 in this study. 440 PANCOAST TUMOR PRESENTING WITH ARM PAIN F. Koc1 , H. Bozdemir1 , S. Paydas2 . 1 Neurology, 2 Oncology, Cukurova University, Adana, Turkey Introduction: Although trauma is the main cause of the plexopathies, it may be seen by the tumoral invasion as well. Pulmonar apex tumors named Pancoast may lead to pain of the arm due to brachial plexus lower truncus invasion. Objectives: We presented 2 male patients with Pancoast tumor which first presentation was pain of the arm. Results: 45 years old male patient with the 3 months of complaint of severe right shoulder pain which is ranging to the upper arm and irresponsive to analgesics admitted to the clinic. Horner Syndrome at the right eye has been determined in neurological examination. The radiologic investigations showed tumor at the pulmonary apex at the right. Servical MRI has demonstrated a mass lesion located centerally at the right anterior mediastenum extending to lower servical levels and thereby invading plexus. 55 years old male patient with severe pain at the left arm which is irresponsive to analgesics admitted to the clinic. He reported right arm pain beginning approximatley 1 year ago and along the way syptoms of fatigue, weight loss and cough added, eventually he had a diagnosis of small cell pulmonary cancer. There were no further investigation regarding pain of the arm although it was the first symptom. Horner Syndrome at the right eye, right monoparesis at the level of 3-/5 has been observed in neurological examination. Servical MRI demonstrated brachial plexus invasion. Conclusions: Patients presenting with the pain of arm should be taken cautiously because of the pulmonary cancer and similar pathology possibility.
125
medication such as antidepressants, anticonvulsants and local anesthetics were administered based on pain category (nociceptive, neuropathic or both) as well as particular characteristics. Results: Pain was mostly due to the cancer itself throughout the entire follow up. Approximately 80% of patients with head and neck cancer experience exclusively nociceptive pain and 24% experience both nociceptive and neuropathic pain. The presence of neuropathic pain was directly associated with the nerve destruction following radical neck dissection (P-value<0.001). Analgesic medication based on the WHO’s 3 step ladder. Pain intensity was greatly reduced within a week of treatment. The difference between the pain score at the beginning and the median score throughout the study, was statistically significant lower (P-value<0.001). Other symptoms like insomnia, anorexia, constipation were also statistically significantly (P-value<0.001) improved. Symptoms such as sweats, shortness of breath and nausea were transient and easily treated. Conclusions: Head and neck cancer patients experience pain in the final stages of their disease. The administration of analgesic and adjuvant medication according etiology, based on WHO’s three step analgesic ladder results in the resolution of pain. 442 THE ROLE OF KETAMINE IN THE MANAGEMENT OF NEUROPATHIC CANCER PAIN – A POLISH EXPERIENCE W. Leppert. Chair and Department of Palliative Medicine, Poznan University of Medicial Sciences, Poznan, Poland Objective: To assess analgesic efficacy and adverse effects of ketamine in the treatment of neuropathic cancer pain. Patients and methods: A retrospective evaluation of 30 patients with severe cancer neuropathic pain, which did not respond to opioid therapy. All patients were treated at the in-patient palliative medicine unit at the Chair and Department of Palliative Medicine of Poznan University. Ketamine was administered in continuous infusion subcutaneously (11 patients) or intravenously (19 patients). All patients treated with ketamine received also morphine and midazolam. Analgesia was assessed by 11-point NRS (Numerical Rating Scale: 0-no pain, 10-unbearable pain), adverse effects by verbal scale (0-none, 1-weak, 2-moderate, 3-severe). Results: The treatment time was 3–68 (median 31) days, daily doses of ketamine were 20–250 mg (median 84 mg). Good analgesia (NRS < 4) was achieved in 20 (67%), partial effect (NRS 4–5) in 9 (30%), ineffective treatment (NRS > 5) in 1 (3%) patient. No respiratory depression was observed. The tolerance of the therapy was acceptable with most frequent adverse effect reported sedation (12 patients: in 5 mild, in 6 moderate, in 1 severe, which decrease after dose reduction). Five patients experienced mild dizziness and two patients bad dreams. Conclusions: The addition of ketamine to opioid therapy increased significantly analgesic effect comparing to opioids administered alone. A close monitoring, start with low ketamine dose and the addition of midazolam may decrease adverse effects incidence and intensity.
441 PAIN MANAGEMENT BASED ON THE ETIOLOGY AND MECHANISM OF PAIN IN HEAD AND NECK CANCER E. Lampropoulou, A. Makris, V. Dimopoulou, K. Apostolopoulos. Hospital of Kalamata, Kalamata, Greece
443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS A. Vadalouca1 , E. Raptis2 , A. Moutzouri1 , E. Stavropoulou1 , I. Siafaka1 , E. Argyra1 . 1 A’ Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of Athens, 2 Pfizer Hellas, Athens, Greece
Objectives: To examine the causes and mechanisms of pain in Greek patients with he ad and neck cancer and the effectiveness of the World Health Organization (WHO) guidelines for pain management. Methods: Data were collected from 103 patients (73 male, 30 female). Particular pain syndromes were categorized based on pain etiology and mechanism. Treatment was based on the World Health Organization (WHO) “three step analgesic ladder”. Adjuvant
Introduction: Escalation of opioid dose remains a common practice for the management of inadequately controlled cancer pain. Unfortunately, in the case of neuropathic cancer pain, this practice often shows poor analgesic results and/or increased incidence of opioid-related side effects. The role of specific adjuvants has not been adequately investigated. Objectives: To examine whether the addition of pregabalin in neuropathic cancer pain resistant to a combination of opioids, NSAIDs,