Cancer pain relief in dying patients

ANTI-INFLAMlrlAToRY DRUGS FOR NERVE PAIN IN CANCER.

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Hovestadt* and Charles J. Vecht* (Spon: J.H. Mulder). Department of Neurology , Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.

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AIM OF INVELSTIGATICN: Uncertainty exist hw nerve pain in cancer should he treated. Anti-inflarmnatorv drugs or ooioids are often considered to he not or only partially effective.Apa& frgneuropathic pain, there are indications that there is also a nociceptive type of nerve pain. Ashury and Fields designated this as nerve trunk pain based on stimulation of the nociceptive free nerve endings present in the epi-, periand endoneurium of the nerve root or plexus (Neurology 1984; 34: 1587-90). If their assumption is true, one may expect such a nociceptive nerve pain to respond to NSAID’s or opioid Therefore, we examined the effect of a NSAID in cancer patients with drugs. severe pain due to a radiculopathy or plexopathy of new onset in an open study. METHODS ANDRESDLTS:Patients had their pain in the distribution of a nerve root or plexus which was caused hy a rontgenologically verified vertebral The acccanpanying local hone pain of a metastasis or tumour recurrence. Nine patients were vertebral metastasis was less severe than the nerve pain. orally, divided treated during one week with naproxen (1500 to 2000 q/day), over three doses. Four patients already used codeine with acetaminophen which The pain score was assessed by was unalteredly continued during the study. The average painscore means of a numerical rating scale from 0 to 10. decreased significantly (p<.OO3) from 7.2 (sd 0.9) to 4.8 (sd 2.0) after one week of taking naproxen. Eight of the nine patients decreased 2 points or more in pain score. One patient showed an increase in pain. CONCLus1oN: These results warrant further study to see whether a nocicep tive type of nerve pain exists and to what extent it responds to treatment with conventional analgesic drugs.

CANCER PAIN RELIEF IN DYING PATIENTS. S. Grond,

D. Zech, T. Meuser*, B. Stobbe*, K.A. LAmann Dept. of Anesthesrology, University of Cologne, 5 Kdln 41, W-Germany

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system. KESULTSz Gn the last day before death 366 (91%) patients were treated with systemic analgesics, 23 (6%) with e idural o ioids and 12 (3%) needed no regular anal esics being painfree from previous radiation or neuro&ic blocb. 361 (90%) patients recieved additiona f adjuvant drugs, e.g. steroids, neuroleptics or antidepressants.

Tablelf Treatment Oral Non-opioidanalgesics 16 + weakopioids39 + strongopioids 133 Parenteral

Non-opioid analgesics 6 + weak opioids 25 + strong opioids 147

( 4%) jlO9$ (33%) ( 1%) ( 6%) (37%)

Table2: Painintensitv ratinns 82 Comaor unknown Nopain 209

Mild pain Moderate pain Severe pain Very severe pain Asbadascouldbe

68 28 13 1

(20%)

(52%j (17%) ( 7%) ( 3%) ( 0%)

stron opioids, mo hine was used in average ioses if?&85 mgld (range 30mg/d (range 30-98 mg/d) for parenteral therapy. Patients who rated severe pain recieved rescue medications (e.g. 10 mg morphine s.c.). CONCLUSIONS:Cancer pain can be treated satisfactorily until death. The use of analgesic and adjuvant drugs according to WHO-Guidelines is still effective during the last days and hours of live, even in patients having been treated with opioids for a long period of time. In 249 of 280 patients needing 960 mg/d) for oral and 83rt85