- Email: [email protected]
F257 THE USE OF METHADONE FOR REFRACTORY NEUROPATHIC CANCER PAIN
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
Conclusions: The capsaicin 8% patch provides pain relief in patients with a range of NP conditions and in a real-life clinical setting appears to be as effective for other conditions as for PHN. Peripheral neuropathy (n = 26) Mean reduction in NPRS from baseline to Weeks 1–8, % Patients with ≥30% decrease in NPRS, n (%) Patients with ≥50% decrease in NPRS, n (%)
PHN (n = 15)
FBSS/ radiculopathy (n = 6)
Polyneuropathy (n = 2)
Neuropathy of the face (n = 2)
−55.8
−50.3
−23.4
−25.4
−59.1
19 (73.1)
10 (66.7)
4 (66.7)
2 (50.0)
2 (100)
16 (61.5)
10 (66.7)
2 (33.3)
1 (25.0)
1 (50.0)
Disclosure: T. Wagner has received speaker and consultancy fees from Astellas Pharma Europe Ltd. A. Roth-Daniek has received consultancy fees from Astellas Pharma Europe Ltd. C. Poole is a Research consultant/analyst for Astellas.
F257 THE USE OF METHADONE FOR REFRACTORY NEUROPATHIC CANCER PAIN E.J. Goraj ´ *, B. Stypuła-Ciuba, J. Jarosz. Dept. of Anaesthesiology and Palliative Care, Cancer Centre-Institute, Warsaw, Poland Background: Methadone is a potent agonist of opioid and NMDA receptors. Inhibits the development of opioids tolerance. Inhibits synaptic serotonin reuptake. Rarely used in Poland due to lack of refund (up to October 2010). Neuropathic pain is an unsolved problem in cancer patients receiving long term opioids and adjuvant therapy. About 80% patients need opioid rotation or changing of application way during progress of disease. Method: All patients suffering refractory, neuropathic pain due to advanced cancer and local infiltrations were admitted to Palliative Medicine Word since September – till December 2010. Reasons of opioid rotations was dominant neuropathic pain, not responding to opioids and adjuvants. We used equipotent doses: morphine to methadone 10:1, fentanyl to methadone 1:10. None of the patients exceed daily dose of opioids equianalgesic 300 mg of morphine. Results: Eight patients (5 women, 3 men) age 36–74, treated before admission with opioids and adjuvants. Opioids were rotated for methadone during 3 days. Pain score and opioids consumption were assessed. All patients achieved better pain control. Average VAS on admission was 9, on methadone 4, 2 and reduction of adjuvants doses. Conclusions: Methadone gives good neuropathic pain control without significant side effects. Opioids rotation on methadone can be considered as an effective alternative to opioids and adjuvants doses escalation. We suggest early rotation for methadone in case of neuropathic pain not responding to opioids and adjuvants treatment. Disclosure: None declared
F258 IDENTIFYING PREDICTORS FOR CHRONIFICATION OF NEUROPATHIC PAIN – RESULTS OF A DELPHI SURVEY S. Boogaard1,2 *, M.W. Heymans3,4 , J. Patijn5 , H.C.W. de Vet3,4 , C.G. Faber6 , M.L. Peters7 , S.A. Loer1 , W.W.A. Zuurmond1,2 , R.S.G.M. Perez1,2,3 . 1 Department of Anaesthesiology, VU University Medical Center, Amsterdam, 2 Trauma Related Neuronal Dysfunction (TREND), Delft, 3 EMGO+ Institute for Health and Care Research, 4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, 5 Pain Management and Research Centre (PKC) Maastricht, 6 Department of Neurology, Maastricht University Medical Centre, 7 Department of Clinical Psychology, Maastricht University, Maastricht, The Netherlands Background and Aims: Chronic Neuropathic Pain (CNP) has a major impact on quality of life (QoL) of patients. Knowledge of predictors for chronification of NP is important to improve Neuropathic Pain
141
(NP)-care. This study aimed at identifying possible predictors from experts. Methods: A two-round Delphi-study was performed among 17 experts in the field of NP. Selection of the panel was based on citation index ranking for NP-related research and/or membership of the NP special interest group of the IASP, complemented with experts with demonstrated field knowledge. Potential predictors were categorized according to the International Classification of Functioning, Disability and Health (ICF) model. Participants were asked to identify important predictors, to suggest new predictors and to grade their importance on a 0–10 scale. Predictors were deemed important if the median score was ≥7 (IQR ≤3). Results: In the first round, 20 predictors were selected and 58 were added by the experts. In the second round, 12 predictors were considered important, divided over the different categories of the ICF-model, including personal factors (4, e.g. depression), environmental factors (1: surgery), functions & structure (6, e.g. allodynia) and participation & QoL (1: trait anxiety). Presence of depression and catastrophizing were considered the most important predictors for CNP (median≥8;IQR≤2). Conclusions: Personal factors and NP symptoms were graded as important predictors for CNP, activities and environmental factors were found to be less important. The possible predictors obtained by this study may serve as a basis for the development of a prediction rule for CNP. Disclosure: None declared
F259 CLINICAL, PSYCHOLOGICAL AND NEUROPHYSIOLOGICAL ASPECTS OF CENTRAL PAIN SYNDROME IN MULTIPLE SCLEROSIS M.V. Churyukanov1,2 *, V.V. Alekseev1 , M.L. Kukushkin1 , N.A. Krupina1 , G.G. Toropina1 , N.N. Yakhno1 . 1 A.Ya. Kozhevnikov Nervous Diseases Clinic, I. M. Sechenov First Moscow State Medical University, 2 Laboratory of Pathophysiology of Pain, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, Moscow, Russia Background and Aims: To investigate clinical, psychological and neurophysiological features patients with central pain syndrome (CPS) in multiple sclerosis (MS). Methods: 60 patients with MS have been divided into 2 equal groups – with and without CPS. Groups were comparable in age, sex and duration of the disease. Examination: neurological, psychological, neurophysiological (SEP, QST, EEG), MRI. Results: Patients’ age, duration and form of disease did not associate with CPS. CPS in MS associated with presence of sensory disturbances. No differences in level of depression, anxiety or fatigue were elicited. CPS associated with high level in catastrophization and illness-focused coping strategies with pain (guarding, resting). According to SCL-90R somatization and psychoticism accompanied CPS. In QST signs of disturbance of pain and temperature sensation were observed in both groups. Changes in SEP confirmed the lesion of somatosensory system in all MS patients with CPS. MRI has not revealed prominent features accompanying pain syndrome in MS. Absolute power for the beta and theta bands in background EEG activity was increased in patients with CPS. Conclusions: The lesion of somatosensory inputs from pain region is obligatory condition for CPS in MS. Personal and psychological features of patient substantially participate in formation of CPS. The different EEG spectral patterns can represent changes, indicating the predisposition to CPS. Significant distinctions between groups in pain reactivity, mechanisms of adaptation, EEG spectral power activity and the absence of other specific differences make it possible to discuss insufficiency of descending inhibitory mechanisms in MS patients with CPS. Disclosure: None declared
Conclusions: The capsaicin 8% patch provides pain relief in patients with a range of NP conditions and in a real-life clinical setting appears to be as effective for other conditions as for PHN. Peripheral neuropathy (n = 26) Mean reduction in NPRS from baseline to Weeks 1–8, % Patients with ≥30% decrease in NPRS, n (%) Patients with ≥50% decrease in NPRS, n (%)
PHN (n = 15)
FBSS/ radiculopathy (n = 6)
Polyneuropathy (n = 2)
Neuropathy of the face (n = 2)
−55.8
−50.3
−23.4
−25.4
−59.1
19 (73.1)
10 (66.7)
4 (66.7)
2 (50.0)
2 (100)
16 (61.5)
10 (66.7)
2 (33.3)
1 (25.0)
1 (50.0)
Disclosure: T. Wagner has received speaker and consultancy fees from Astellas Pharma Europe Ltd. A. Roth-Daniek has received consultancy fees from Astellas Pharma Europe Ltd. C. Poole is a Research consultant/analyst for Astellas.
F257 THE USE OF METHADONE FOR REFRACTORY NEUROPATHIC CANCER PAIN E.J. Goraj ´ *, B. Stypuła-Ciuba, J. Jarosz. Dept. of Anaesthesiology and Palliative Care, Cancer Centre-Institute, Warsaw, Poland Background: Methadone is a potent agonist of opioid and NMDA receptors. Inhibits the development of opioids tolerance. Inhibits synaptic serotonin reuptake. Rarely used in Poland due to lack of refund (up to October 2010). Neuropathic pain is an unsolved problem in cancer patients receiving long term opioids and adjuvant therapy. About 80% patients need opioid rotation or changing of application way during progress of disease. Method: All patients suffering refractory, neuropathic pain due to advanced cancer and local infiltrations were admitted to Palliative Medicine Word since September – till December 2010. Reasons of opioid rotations was dominant neuropathic pain, not responding to opioids and adjuvants. We used equipotent doses: morphine to methadone 10:1, fentanyl to methadone 1:10. None of the patients exceed daily dose of opioids equianalgesic 300 mg of morphine. Results: Eight patients (5 women, 3 men) age 36–74, treated before admission with opioids and adjuvants. Opioids were rotated for methadone during 3 days. Pain score and opioids consumption were assessed. All patients achieved better pain control. Average VAS on admission was 9, on methadone 4, 2 and reduction of adjuvants doses. Conclusions: Methadone gives good neuropathic pain control without significant side effects. Opioids rotation on methadone can be considered as an effective alternative to opioids and adjuvants doses escalation. We suggest early rotation for methadone in case of neuropathic pain not responding to opioids and adjuvants treatment. Disclosure: None declared
F258 IDENTIFYING PREDICTORS FOR CHRONIFICATION OF NEUROPATHIC PAIN – RESULTS OF A DELPHI SURVEY S. Boogaard1,2 *, M.W. Heymans3,4 , J. Patijn5 , H.C.W. de Vet3,4 , C.G. Faber6 , M.L. Peters7 , S.A. Loer1 , W.W.A. Zuurmond1,2 , R.S.G.M. Perez1,2,3 . 1 Department of Anaesthesiology, VU University Medical Center, Amsterdam, 2 Trauma Related Neuronal Dysfunction (TREND), Delft, 3 EMGO+ Institute for Health and Care Research, 4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, 5 Pain Management and Research Centre (PKC) Maastricht, 6 Department of Neurology, Maastricht University Medical Centre, 7 Department of Clinical Psychology, Maastricht University, Maastricht, The Netherlands Background and Aims: Chronic Neuropathic Pain (CNP) has a major impact on quality of life (QoL) of patients. Knowledge of predictors for chronification of NP is important to improve Neuropathic Pain
141
(NP)-care. This study aimed at identifying possible predictors from experts. Methods: A two-round Delphi-study was performed among 17 experts in the field of NP. Selection of the panel was based on citation index ranking for NP-related research and/or membership of the NP special interest group of the IASP, complemented with experts with demonstrated field knowledge. Potential predictors were categorized according to the International Classification of Functioning, Disability and Health (ICF) model. Participants were asked to identify important predictors, to suggest new predictors and to grade their importance on a 0–10 scale. Predictors were deemed important if the median score was ≥7 (IQR ≤3). Results: In the first round, 20 predictors were selected and 58 were added by the experts. In the second round, 12 predictors were considered important, divided over the different categories of the ICF-model, including personal factors (4, e.g. depression), environmental factors (1: surgery), functions & structure (6, e.g. allodynia) and participation & QoL (1: trait anxiety). Presence of depression and catastrophizing were considered the most important predictors for CNP (median≥8;IQR≤2). Conclusions: Personal factors and NP symptoms were graded as important predictors for CNP, activities and environmental factors were found to be less important. The possible predictors obtained by this study may serve as a basis for the development of a prediction rule for CNP. Disclosure: None declared
F259 CLINICAL, PSYCHOLOGICAL AND NEUROPHYSIOLOGICAL ASPECTS OF CENTRAL PAIN SYNDROME IN MULTIPLE SCLEROSIS M.V. Churyukanov1,2 *, V.V. Alekseev1 , M.L. Kukushkin1 , N.A. Krupina1 , G.G. Toropina1 , N.N. Yakhno1 . 1 A.Ya. Kozhevnikov Nervous Diseases Clinic, I. M. Sechenov First Moscow State Medical University, 2 Laboratory of Pathophysiology of Pain, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, Moscow, Russia Background and Aims: To investigate clinical, psychological and neurophysiological features patients with central pain syndrome (CPS) in multiple sclerosis (MS). Methods: 60 patients with MS have been divided into 2 equal groups – with and without CPS. Groups were comparable in age, sex and duration of the disease. Examination: neurological, psychological, neurophysiological (SEP, QST, EEG), MRI. Results: Patients’ age, duration and form of disease did not associate with CPS. CPS in MS associated with presence of sensory disturbances. No differences in level of depression, anxiety or fatigue were elicited. CPS associated with high level in catastrophization and illness-focused coping strategies with pain (guarding, resting). According to SCL-90R somatization and psychoticism accompanied CPS. In QST signs of disturbance of pain and temperature sensation were observed in both groups. Changes in SEP confirmed the lesion of somatosensory system in all MS patients with CPS. MRI has not revealed prominent features accompanying pain syndrome in MS. Absolute power for the beta and theta bands in background EEG activity was increased in patients with CPS. Conclusions: The lesion of somatosensory inputs from pain region is obligatory condition for CPS in MS. Personal and psychological features of patient substantially participate in formation of CPS. The different EEG spectral patterns can represent changes, indicating the predisposition to CPS. Significant distinctions between groups in pain reactivity, mechanisms of adaptation, EEG spectral power activity and the absence of other specific differences make it possible to discuss insufficiency of descending inhibitory mechanisms in MS patients with CPS. Disclosure: None declared