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The use of morphine in cancer pain — A German problem?
S26
lournal
of Pain and Svmbtom Management
Vol. 3 No. 3 Stimrne? I98%
61
62
ANAuxs1c USE IN AWAXED CANCERPATIDVS
PRESCRIBING AND CONSUMPTION PATTERNS OF ANALGESIC AND AOJUVANT DRUGS IN A MAJOR TERTIARY CANCER CENTER. G Barkas, ME Keaveney, KM Foley, RK Portenoy. Depts of Pharmacy and Pain Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY U.S.A. Medication records of 421 inpatients at HSKCC were reviewed to assess prescribing and consumption patterns Prescriptions of analgesic and sedative/hypnotic drugs. and drug consumption during a 24 hr period was recorded for all patients except those in the intensive care unit. At least one non-opioid, opioid, or adjuvant analgesic was prescribed in 48% of pediatric pts, 87% of adult pts, and 83% of elderly pts. 277 pts (66%) were prescribed and 127 (30%) consumed a non-opioid; > 30% of these prescriptions were for acetaminophen. 62% were prescribed an opioid and 46% consumed one. Morphine (33%) and oxycodone-acetaminophen (20%) accounted for most opioids prescribed. 34% of medical and 4.5% of surgical pts prescribed an opioid were offered it around the clock. Adjuvant analgesic prescription and consumption occurred in lo-20% of pts. 57% were prescribed a sedative/hypnotic, of whom 72% received triazolam. These data suggest: 1) non-opioids are often prescribed but less frequently consumed; more than 90% of prescriptions are for acetaminophen. 2) Opioids are commonly prescribed, with morphine and acetaminophenopioid products being preferred; most patients prescribed an opioid consume at least one dose. 3) Many classes of adjuvant drugs accepted as co-analgesics are infrequently prescribed. 4) The use of a benzodiazepine hypnotic is extremely prevalent in this population.
F.J. Rrescia, G. may, R. Pmtenoy, n. Fdler Cd'Ary HOSpital, Rrom~, NY, U.S.A. Marorial Ho~ital, New York, NY, U.S.A. Pain is a frequent patients
with
advanced
an disturbing cancer.
issue for
Studies
of
hospitalized patients indicate sixty to eighty percent in the terminal stage experience significantdisaxnfort. There are no large scale epidemiological studies that review analgesic usage during the final days of life in this patient population. A clinical data base model for advanced cancer patients was developed at Calvary Hospital, an acute care speciality hospitalthatahits uatientswith rxwressive d&se, semrity of bness requir~g~hospitalizaticm end brevity of life noted in weeks. All inpatient admissions (1,103) to Calvary Rmpital during a one year psrid, who expired were prmpectively entered into a study to analyze opioid usam at several mints in tinta: a&i&on,-three
days
a&r
admission
TV
weeks
prior to death, and the last five days of life. ?te specific opioid, twenty-four hour dose given and route of administration was recorded and converted to oral nmrphine equivalents for ease of ccnpltation. A ccnparison of the percent change of narcotic dose is presented as it relates to mltiple variables in the data base.
63 TRANSCULTURAL
64 OBSTACLES
TO
EFFECTIVE PAIN MANAGEMENT.
M. Loscalzo, N. Coyle. Pain Research Program, Memorial Sloan-Ketterinq Cancer Center, New York, NY 10021 USA Over the course of 3 weeks two pain consultants from MSKCC provided a series of training sessions for aooroximately 300 multinational health care professionals'in an Arab country. Patients were over 90% Arabian. Uniformlv, physicians,~nurses, and social workers expressed greatest frustration in managing patients with chronic pain syndromes in general and with advanced cancer. Of primary concern in the management of cancer patients were prescribing practices and the lack of adequate objective measurement instruments. Overall, medical and psychosocial obstacles to the effective management of these patients were: absence of transcultural objective pain management instruments, an acute rather than chronic
model of pain management, and ineffective associated with cultural and fear of psychological Obstacles to adequate country and transcultural similar to those in the tenuous by the prevailing problem-solving approach discussed.
communication
and multiple language barriers dependence/addiction. pain management in this Arabian medical center were found to be western world but were made more sociopolitical climate. A within this context will be
THE USE OF YORPBlNE IN CANCER PAIN - A GEREAN PROBLEM ? Schug S, Zech D, D&r U Dept. of Anesthesiology University of Cologne 5000 Kgln 41, FRG 92.4 * of 174 cancer patients, admitted to the Pain Management Unit of University Hospital of Cologne for inand out-patient paln control, suffered from more than moderate paln (step 3 on a 6-step VRS) under pretreatment by CPs and other physicians. not trained In pain management. An oral drug therapy following the WHO method for cancer pain rellef changed this situation drastically: 67 W of the patients had no or only mild pain immediately after induction of the new therapy. The main reason for thls lnsufflclent pretreatment seems to be the hesltatlon to use strong opiolds and especially morphlne, berldeo underdosage of drugs and lnadaequate lntake schedule: only 19.5 % of patients got a strong oploid although nearly 40 % needed one on admirsion, the respective flgures for morphine being 8.7 96 and 33.4 96. In the authors’ opinion this may not be a typical German situation caused by - most physlclans not belng familiar with morphine and Its use - fear of addiction and tachyphylaxia - restrictive drug lawn, changed unnoticed by most physicians to more useable ones for cancer paln patients.
lournal
of Pain and Svmbtom Management
Vol. 3 No. 3 Stimrne? I98%
61
62
ANAuxs1c USE IN AWAXED CANCERPATIDVS
PRESCRIBING AND CONSUMPTION PATTERNS OF ANALGESIC AND AOJUVANT DRUGS IN A MAJOR TERTIARY CANCER CENTER. G Barkas, ME Keaveney, KM Foley, RK Portenoy. Depts of Pharmacy and Pain Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY U.S.A. Medication records of 421 inpatients at HSKCC were reviewed to assess prescribing and consumption patterns Prescriptions of analgesic and sedative/hypnotic drugs. and drug consumption during a 24 hr period was recorded for all patients except those in the intensive care unit. At least one non-opioid, opioid, or adjuvant analgesic was prescribed in 48% of pediatric pts, 87% of adult pts, and 83% of elderly pts. 277 pts (66%) were prescribed and 127 (30%) consumed a non-opioid; > 30% of these prescriptions were for acetaminophen. 62% were prescribed an opioid and 46% consumed one. Morphine (33%) and oxycodone-acetaminophen (20%) accounted for most opioids prescribed. 34% of medical and 4.5% of surgical pts prescribed an opioid were offered it around the clock. Adjuvant analgesic prescription and consumption occurred in lo-20% of pts. 57% were prescribed a sedative/hypnotic, of whom 72% received triazolam. These data suggest: 1) non-opioids are often prescribed but less frequently consumed; more than 90% of prescriptions are for acetaminophen. 2) Opioids are commonly prescribed, with morphine and acetaminophenopioid products being preferred; most patients prescribed an opioid consume at least one dose. 3) Many classes of adjuvant drugs accepted as co-analgesics are infrequently prescribed. 4) The use of a benzodiazepine hypnotic is extremely prevalent in this population.
F.J. Rrescia, G. may, R. Pmtenoy, n. Fdler Cd'Ary HOSpital, Rrom~, NY, U.S.A. Marorial Ho~ital, New York, NY, U.S.A. Pain is a frequent patients
with
advanced
an disturbing cancer.
issue for
Studies
of
hospitalized patients indicate sixty to eighty percent in the terminal stage experience significantdisaxnfort. There are no large scale epidemiological studies that review analgesic usage during the final days of life in this patient population. A clinical data base model for advanced cancer patients was developed at Calvary Hospital, an acute care speciality hospitalthatahits uatientswith rxwressive d&se, semrity of bness requir~g~hospitalizaticm end brevity of life noted in weeks. All inpatient admissions (1,103) to Calvary Rmpital during a one year psrid, who expired were prmpectively entered into a study to analyze opioid usam at several mints in tinta: a&i&on,-three
days
a&r
admission
TV
weeks
prior to death, and the last five days of life. ?te specific opioid, twenty-four hour dose given and route of administration was recorded and converted to oral nmrphine equivalents for ease of ccnpltation. A ccnparison of the percent change of narcotic dose is presented as it relates to mltiple variables in the data base.
63 TRANSCULTURAL
64 OBSTACLES
TO
EFFECTIVE PAIN MANAGEMENT.
M. Loscalzo, N. Coyle. Pain Research Program, Memorial Sloan-Ketterinq Cancer Center, New York, NY 10021 USA Over the course of 3 weeks two pain consultants from MSKCC provided a series of training sessions for aooroximately 300 multinational health care professionals'in an Arab country. Patients were over 90% Arabian. Uniformlv, physicians,~nurses, and social workers expressed greatest frustration in managing patients with chronic pain syndromes in general and with advanced cancer. Of primary concern in the management of cancer patients were prescribing practices and the lack of adequate objective measurement instruments. Overall, medical and psychosocial obstacles to the effective management of these patients were: absence of transcultural objective pain management instruments, an acute rather than chronic
model of pain management, and ineffective associated with cultural and fear of psychological Obstacles to adequate country and transcultural similar to those in the tenuous by the prevailing problem-solving approach discussed.
communication
and multiple language barriers dependence/addiction. pain management in this Arabian medical center were found to be western world but were made more sociopolitical climate. A within this context will be
THE USE OF YORPBlNE IN CANCER PAIN - A GEREAN PROBLEM ? Schug S, Zech D, D&r U Dept. of Anesthesiology University of Cologne 5000 Kgln 41, FRG 92.4 * of 174 cancer patients, admitted to the Pain Management Unit of University Hospital of Cologne for inand out-patient paln control, suffered from more than moderate paln (step 3 on a 6-step VRS) under pretreatment by CPs and other physicians. not trained In pain management. An oral drug therapy following the WHO method for cancer pain rellef changed this situation drastically: 67 W of the patients had no or only mild pain immediately after induction of the new therapy. The main reason for thls lnsufflclent pretreatment seems to be the hesltatlon to use strong opiolds and especially morphlne, berldeo underdosage of drugs and lnadaequate lntake schedule: only 19.5 % of patients got a strong oploid although nearly 40 % needed one on admirsion, the respective flgures for morphine being 8.7 96 and 33.4 96. In the authors’ opinion this may not be a typical German situation caused by - most physlclans not belng familiar with morphine and Its use - fear of addiction and tachyphylaxia - restrictive drug lawn, changed unnoticed by most physicians to more useable ones for cancer paln patients.