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690 EXPERIENCE OF TREATMENT OF 10,411 PATIENTS IN RUSSIA
S180
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
688 THE EFFECTIVENESS AND TOLERANCE OF OXYCODONE IN OPIOID SWITCHING
690 EXPERIENCE OF TREATMENT OF 10,411 PATIENTS IN RUSSIA
V. Ortiz ° , A. Arroita, M. L´opez, L. Aguilera. Pain Unit, Department of Anaesthesia and Reanimation, Hospital De Basurto, Bilbao, Spain
N.A. Osipova1 ° , V.V. Osipova1 , N.I. Lubitsev1 , M.V. Lukianov2 . 1 Herzen Research Oncology Institute, Moscow, 2 National Research Center of Surgery, Moscow, Russia
Introduction: The opioid switching has been proposed as being effective in the treatment of pain, improving the efficacy of the first opioid or tolerance to adverse effects. Materials and Methods: 50 patients were studied with chronic nononcological pain, receiving opioid treatment with an insufficient analgesic effect (56%), or which was intolerated, and who were subsequently rotated to oxycodone. The analgesic effect was evaluated using EVA and noting the adverse effects (dizziness, drowsiness, nausea, dry mouth and constipation). Results: Pain control (table 1) Table 1 Pain control
Day 15
Day 30
Day 90
Excellent ↓ EVA >70% Good ↓ EVA 50−70% Normal ↓ EVA 30−50% Bad ↓ EVA <30%
16% 50% 24% 10%
20% 46% 24% 10%
18% 54% 18% 10%
Adverse effects: Constipation: 22%; Dizziness: 18%; Drowsiness: 26%; Dry mouth: 12%; Nausea: 6%. In 10% of cases, the treatment was suspended: 6% due to ineffectiveness and 4% due to intolerance. Conclusions: 1. Opioid switching is effective in the treatment of non-oncological pain 2. Oxycodone is effective, safe, and well-tolerated in opioid switching 3. Opioid present inter-individual variations, both in terms of analgesic efficacy and adverse effects.
689 TRANSDERMAL BUPRENORPHINE IN THE TREATMENT OF NEUROPATHIC PAIN A. Orts1 ° , R. Salda˜na1 , A. Hermira2 . 1 Unidad del Dolor, Cl´ınica Universal, Madrid, 2 Anestesia y Reanimaci´on, Hospital Doce De Octubre, Madrid, Spain Background and Aims: Treatment of neuropathic pain with opioid analgesics is controversial. Some studies have indicated that neuropathic is only slightly responsive to opioid analgesics. However, several studies show that adequate analgesia can be obtained, since opioids produce analgesia by affecting different pain pathways. Methods: In the present study we tested effectiveness of buprenorphine in eight neuropathic pain patients of our Chronic Pain Unit, and who received transdermal buprenorphine (Transtec® , Gr¨unenthalTM ). We registered their diagnosis, maintenance doses of buprenorphine, therapeutic effectiveness and adverse effects. Results: Eight neuropathic patients who received transdermal buprenorphine were evaluated. The average age was 60 years-old, and 62.5% of patients were female. Diagnoses were: a) Paresthetic meralgia of the femoral cutaneous nerve (2 cases) b) Diabetic neuropathy (1 case) c) Brachial plexopathy (2 cases) d) Dorsal neuralgia (1 case) e) Posthoracotomy pain (1 case) f) Trigeminal neuralgia (1 case). Average doses of transdermal buprenorphine were 35.9 mcg/h. Maximal doses were 52.5 mcg/h. Pain turned from severe into mild-moderate pain in 50% of the patients. Both cases of brachial plexopathy, and one of two cases of paresthetic meralgia improved. No pain relief was observed in patients with trigeminal neuralgia. Posthoracotomy pain was adequately reduced by buprenorphine. In dorsal neuralgia and diabetic neuropathy patients, buprenorphine patch had to be removed due to side effects (local reactions in the first case, and nausea-vomiting in the second). Conclusions: Transdermal buprenorphine is a well tolerated and safe drug, that can be considered an effective therapy for patients with neuropathic pain.
Background and Aims: The stable combination of tramadol 37.5 mg/ paracetamol 325 mg (Zaldiar – Z) possesses three mechanisms of action. Russian Program GARANT focused on pharmaco-epidemiology of various types of acute and chronic pain (AP, CP). Methods: Open multicentral non-interventional observations conducted with 10,411 patients (age 48.1±1.5, F – 54.8%, M – 45.2%) with AP and CP. Clinical diagnoses, concomitant diseases, pain relief (VRC 0−4), BP and HR, doses of Z, adverse events (AE), withdrawal ratio were registered. Results: The list of 65 pain diagnoses summarized in vertebrogenic pain (34.9%), posttraumatic (24%), pain in joints (15.4%), out-patients post-op pain relief (11.8%), etc. The baseline pain: moderate – 31.8%, severe – 68.2%. Dose of Z was 2.7 + 1.5 tabs in the first day of therapy. Pain significantly decreased or stopped in 88% of patients with moderate and in 80.1% with severe baseline pain in 6 hours. Pain significantly decreased or stopped in 97% – moderate and 99% – severe at the 7th day of therapy (Z 1.7 + 1.4 tabs). AE were seen in 6.6% of patients: dizziness 1.5%, somnolence 0.7%, nausea 1.9%, vomiting 0.1%, skin reactions 0.2%, etc. Nausea and vomiting were the reasons for withdrawal in 0.25% of patients. Conclusion: In this study Z was effective, had favorable safety profile in AP and CP with moderate to severe degree.
691 TRAMADOL/PARACETAMOL (ZALDIAR): EXPERIENCE OF TREATMENT OF 10,411 PATIENTS IN RUSSIA N.A. Osipova ° , V.V. Osipova, N.I. Lubitsev, M.V. Lukianov. Moscow P.A. Herzen Research Oncology Institute, Moscow, Russia Background and Objectives: The stable combination of tramadol 37.5 mg/paracetamol 325 mg (Zaldiar – Z) possesses three mechanism of action. Russian Program GARANT focused on pharmacoepidemiology of various types of acute and chronic pain (AP, CP). Methods: Open non-interventional observations conducted with 10,411 patients (age 48.1+1.5, F – 54.8%, M – 45.2%) with AP and CP. Clinical diagnoses, concomitant diseases, pain relief (VRC 0−4), BP and HR, doses of Z, adverse events (AE), withdrawal ratio were registered. Results: The list of 65 pain diagnoses summarized in vertebrogenic pain (34.9%), posttraumatic (24%), pain in joints (15.4%), out-patients post-op pain relief (11.8%), etc. The baseline pain: moderate – 31.8%, severe – 68.2%. Dose of Z was 2.7+1.5 tabs. in the first day of therapy. Pain significantly decreased or stopped in 88% of patients with moderate and in 80.1% with severe baseline pain in 6 hours. Pain was absent in 83% of patients with moderate and 67% with severe baseline pain at the 7th day of therapy (Z 1.7+1.4 tabs). AE were seen in 6.6% of patients: dizziness 1.5%, somnolence 0.7%, nausea 1.9%, vomiting 0.1%, skin reactions 0.2%, etc. Nausea and vomiting were the reasons for withdrawal in 0.25% of patients. Conclusion: In this study Z was effective, had favorable safety profile in AP and CP with moderate to severe degree.
692 OPIOID TREATMENT FOR BREAKTROUGH PAIN IN PATIENTS WITH CHRONIC NON-CANCER PAIN E. Ozyuvaci ° , F. Kutlu. Department of Anesthesiology and Reanimation, S.B. Istanbul Educational and Research Hospital, Istanbul, Turkiye Background and Aims: The aim of the study the current pharmacologic management of breakthrough pain in chronic pain in non-cancer patients. Methods: This is a 5 months (January–May 2006) prospective study has initiated in our pain clinic. We followed up 40 non-cancer patients. Response to treatment was evaluated by a visual analogue scale of pain
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
688 THE EFFECTIVENESS AND TOLERANCE OF OXYCODONE IN OPIOID SWITCHING
690 EXPERIENCE OF TREATMENT OF 10,411 PATIENTS IN RUSSIA
V. Ortiz ° , A. Arroita, M. L´opez, L. Aguilera. Pain Unit, Department of Anaesthesia and Reanimation, Hospital De Basurto, Bilbao, Spain
N.A. Osipova1 ° , V.V. Osipova1 , N.I. Lubitsev1 , M.V. Lukianov2 . 1 Herzen Research Oncology Institute, Moscow, 2 National Research Center of Surgery, Moscow, Russia
Introduction: The opioid switching has been proposed as being effective in the treatment of pain, improving the efficacy of the first opioid or tolerance to adverse effects. Materials and Methods: 50 patients were studied with chronic nononcological pain, receiving opioid treatment with an insufficient analgesic effect (56%), or which was intolerated, and who were subsequently rotated to oxycodone. The analgesic effect was evaluated using EVA and noting the adverse effects (dizziness, drowsiness, nausea, dry mouth and constipation). Results: Pain control (table 1) Table 1 Pain control
Day 15
Day 30
Day 90
Excellent ↓ EVA >70% Good ↓ EVA 50−70% Normal ↓ EVA 30−50% Bad ↓ EVA <30%
16% 50% 24% 10%
20% 46% 24% 10%
18% 54% 18% 10%
Adverse effects: Constipation: 22%; Dizziness: 18%; Drowsiness: 26%; Dry mouth: 12%; Nausea: 6%. In 10% of cases, the treatment was suspended: 6% due to ineffectiveness and 4% due to intolerance. Conclusions: 1. Opioid switching is effective in the treatment of non-oncological pain 2. Oxycodone is effective, safe, and well-tolerated in opioid switching 3. Opioid present inter-individual variations, both in terms of analgesic efficacy and adverse effects.
689 TRANSDERMAL BUPRENORPHINE IN THE TREATMENT OF NEUROPATHIC PAIN A. Orts1 ° , R. Salda˜na1 , A. Hermira2 . 1 Unidad del Dolor, Cl´ınica Universal, Madrid, 2 Anestesia y Reanimaci´on, Hospital Doce De Octubre, Madrid, Spain Background and Aims: Treatment of neuropathic pain with opioid analgesics is controversial. Some studies have indicated that neuropathic is only slightly responsive to opioid analgesics. However, several studies show that adequate analgesia can be obtained, since opioids produce analgesia by affecting different pain pathways. Methods: In the present study we tested effectiveness of buprenorphine in eight neuropathic pain patients of our Chronic Pain Unit, and who received transdermal buprenorphine (Transtec® , Gr¨unenthalTM ). We registered their diagnosis, maintenance doses of buprenorphine, therapeutic effectiveness and adverse effects. Results: Eight neuropathic patients who received transdermal buprenorphine were evaluated. The average age was 60 years-old, and 62.5% of patients were female. Diagnoses were: a) Paresthetic meralgia of the femoral cutaneous nerve (2 cases) b) Diabetic neuropathy (1 case) c) Brachial plexopathy (2 cases) d) Dorsal neuralgia (1 case) e) Posthoracotomy pain (1 case) f) Trigeminal neuralgia (1 case). Average doses of transdermal buprenorphine were 35.9 mcg/h. Maximal doses were 52.5 mcg/h. Pain turned from severe into mild-moderate pain in 50% of the patients. Both cases of brachial plexopathy, and one of two cases of paresthetic meralgia improved. No pain relief was observed in patients with trigeminal neuralgia. Posthoracotomy pain was adequately reduced by buprenorphine. In dorsal neuralgia and diabetic neuropathy patients, buprenorphine patch had to be removed due to side effects (local reactions in the first case, and nausea-vomiting in the second). Conclusions: Transdermal buprenorphine is a well tolerated and safe drug, that can be considered an effective therapy for patients with neuropathic pain.
Background and Aims: The stable combination of tramadol 37.5 mg/ paracetamol 325 mg (Zaldiar – Z) possesses three mechanisms of action. Russian Program GARANT focused on pharmaco-epidemiology of various types of acute and chronic pain (AP, CP). Methods: Open multicentral non-interventional observations conducted with 10,411 patients (age 48.1±1.5, F – 54.8%, M – 45.2%) with AP and CP. Clinical diagnoses, concomitant diseases, pain relief (VRC 0−4), BP and HR, doses of Z, adverse events (AE), withdrawal ratio were registered. Results: The list of 65 pain diagnoses summarized in vertebrogenic pain (34.9%), posttraumatic (24%), pain in joints (15.4%), out-patients post-op pain relief (11.8%), etc. The baseline pain: moderate – 31.8%, severe – 68.2%. Dose of Z was 2.7 + 1.5 tabs in the first day of therapy. Pain significantly decreased or stopped in 88% of patients with moderate and in 80.1% with severe baseline pain in 6 hours. Pain significantly decreased or stopped in 97% – moderate and 99% – severe at the 7th day of therapy (Z 1.7 + 1.4 tabs). AE were seen in 6.6% of patients: dizziness 1.5%, somnolence 0.7%, nausea 1.9%, vomiting 0.1%, skin reactions 0.2%, etc. Nausea and vomiting were the reasons for withdrawal in 0.25% of patients. Conclusion: In this study Z was effective, had favorable safety profile in AP and CP with moderate to severe degree.
691 TRAMADOL/PARACETAMOL (ZALDIAR): EXPERIENCE OF TREATMENT OF 10,411 PATIENTS IN RUSSIA N.A. Osipova ° , V.V. Osipova, N.I. Lubitsev, M.V. Lukianov. Moscow P.A. Herzen Research Oncology Institute, Moscow, Russia Background and Objectives: The stable combination of tramadol 37.5 mg/paracetamol 325 mg (Zaldiar – Z) possesses three mechanism of action. Russian Program GARANT focused on pharmacoepidemiology of various types of acute and chronic pain (AP, CP). Methods: Open non-interventional observations conducted with 10,411 patients (age 48.1+1.5, F – 54.8%, M – 45.2%) with AP and CP. Clinical diagnoses, concomitant diseases, pain relief (VRC 0−4), BP and HR, doses of Z, adverse events (AE), withdrawal ratio were registered. Results: The list of 65 pain diagnoses summarized in vertebrogenic pain (34.9%), posttraumatic (24%), pain in joints (15.4%), out-patients post-op pain relief (11.8%), etc. The baseline pain: moderate – 31.8%, severe – 68.2%. Dose of Z was 2.7+1.5 tabs. in the first day of therapy. Pain significantly decreased or stopped in 88% of patients with moderate and in 80.1% with severe baseline pain in 6 hours. Pain was absent in 83% of patients with moderate and 67% with severe baseline pain at the 7th day of therapy (Z 1.7+1.4 tabs). AE were seen in 6.6% of patients: dizziness 1.5%, somnolence 0.7%, nausea 1.9%, vomiting 0.1%, skin reactions 0.2%, etc. Nausea and vomiting were the reasons for withdrawal in 0.25% of patients. Conclusion: In this study Z was effective, had favorable safety profile in AP and CP with moderate to severe degree.
692 OPIOID TREATMENT FOR BREAKTROUGH PAIN IN PATIENTS WITH CHRONIC NON-CANCER PAIN E. Ozyuvaci ° , F. Kutlu. Department of Anesthesiology and Reanimation, S.B. Istanbul Educational and Research Hospital, Istanbul, Turkiye Background and Aims: The aim of the study the current pharmacologic management of breakthrough pain in chronic pain in non-cancer patients. Methods: This is a 5 months (January–May 2006) prospective study has initiated in our pain clinic. We followed up 40 non-cancer patients. Response to treatment was evaluated by a visual analogue scale of pain