Managing Cancer Pain and Symptoms of Outpatients by Rotation to Sustained-release Hydromorphone: A Prospective Clinical Trial
PURPOSEIn this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain. METHODSBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating S...
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| Veröffentlicht in: | The Clinical journal of pain 2006-11, Vol.22 (9), p.770-775 |
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| container_title | The Clinical journal of pain |
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| creator | Wirz, Stefan Wartenberg, Hans Christian Elsen, Christian Wittmann, Maria Diederichs, Marta Nadstawek, Joachim |
| description | PURPOSEIn this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain.
METHODSBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, χ).
RESULTSRotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.
CONCLUSIONSSwitching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact. |
| doi_str_mv | 10.1097/01.ajp.0000210925.33783.4d |
| format | Article |
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METHODSBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, χ).
RESULTSRotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.
CONCLUSIONSSwitching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact.</description><identifier>ISSN: 0749-8047</identifier><identifier>EISSN: 1536-5409</identifier><identifier>DOI: 10.1097/01.ajp.0000210925.33783.4d</identifier><identifier>PMID: 17057558</identifier><identifier>CODEN: CJPAEU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Administration, Oral ; Adult ; Aged ; Ambulatory Care - methods ; Analgesics, Opioid - administration & dosage ; Biological and medical sciences ; Delayed-Action Preparations - administration & dosage ; Drug Administration Schedule ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Hydromorphone - administration & dosage ; Male ; Medical sciences ; Middle Aged ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Neoplasms - complications ; Neoplasms - diagnosis ; Neoplasms - drug therapy ; Neurology ; Pain - diagnosis ; Pain - etiology ; Pain - prevention & control ; Pain Measurement - drug effects ; Pneumology ; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors ; Treatment Outcome ; Tumors of the respiratory system and mediastinum ; Vertebrates: nervous system and sense organs</subject><ispartof>The Clinical journal of pain, 2006-11, Vol.22 (9), p.770-775</ispartof><rights>2006 Lippincott Williams & Wilkins, Inc.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3604-a7a6297ea5c481c1d67109bbac791805a75aff9bd0e4b8b174958dd4e541123a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27926,27927</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18246224$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17057558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wirz, Stefan</creatorcontrib><creatorcontrib>Wartenberg, Hans Christian</creatorcontrib><creatorcontrib>Elsen, Christian</creatorcontrib><creatorcontrib>Wittmann, Maria</creatorcontrib><creatorcontrib>Diederichs, Marta</creatorcontrib><creatorcontrib>Nadstawek, Joachim</creatorcontrib><title>Managing Cancer Pain and Symptoms of Outpatients by Rotation to Sustained-release Hydromorphone: A Prospective Clinical Trial</title><title>The Clinical journal of pain</title><addtitle>Clin J Pain</addtitle><description>PURPOSEIn this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain.
METHODSBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, χ).
RESULTSRotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.
CONCLUSIONSSwitching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact.</description><subject>Administration, Oral</subject><subject>Adult</subject><subject>Aged</subject><subject>Ambulatory Care - methods</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Delayed-Action Preparations - administration & dosage</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Hydromorphone - administration & dosage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - diagnosis</subject><subject>Neoplasms - drug therapy</subject><subject>Neurology</subject><subject>Pain - diagnosis</subject><subject>Pain - etiology</subject><subject>Pain - prevention & control</subject><subject>Pain Measurement - drug effects</subject><subject>Pneumology</subject><subject>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</subject><subject>Treatment Outcome</subject><subject>Tumors of the respiratory system and mediastinum</subject><subject>Vertebrates: nervous system and sense organs</subject><issn>0749-8047</issn><issn>1536-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMFu1DAQhiMEotvCKyALCW5Z7MSOnd6qVWmRilrRcrYmyaTr4tjBdqj2wLvjsiutL9aMvt_j-YriI6NrRlv5hbI1PM1rmk-VG5VY17VU9ZoPr4oVE3VTCk7b18WKSt6WinJ5UpzG-EQpE5Wib4sTJqmQQqhV8fc7OHg07pFswPUYyB0YR8AN5H43zclPkfiR3C5phmTQpUi6HfnhU668I8mT-yWmHMGhDGgRIpLr3RD85MO89Q7PyQW5Cz7O2CfzB8nGGmd6sOQhGLDvijcj2IjvD_dZ8fPr5cPmury5vfq2ubgp-7qhvAQJTdVKBNFzxXo2NDLv3XXQy5YpKkAKGMe2GyjyTnUsry3UMHAUnLGqhvqs-Lx_dw7-94Ix6cnEHq0Fh36JulGtYrUUGTzfg33-cww46jmYCcJOM6pf5GvKdJavj_L1f_maDzn84TBl6SYcjtGD7Qx8OgAQs4MxZOUmHjlV8aaqeOb4nnv2NmGIv-zyjEFvEWza7kcLqsqK0oaxXJUvLV7_AxQtn0Q</recordid><startdate>200611</startdate><enddate>200611</enddate><creator>Wirz, Stefan</creator><creator>Wartenberg, Hans Christian</creator><creator>Elsen, Christian</creator><creator>Wittmann, Maria</creator><creator>Diederichs, Marta</creator><creator>Nadstawek, Joachim</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams and Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200611</creationdate><title>Managing Cancer Pain and Symptoms of Outpatients by Rotation to Sustained-release Hydromorphone: A Prospective Clinical Trial</title><author>Wirz, Stefan ; Wartenberg, Hans Christian ; Elsen, Christian ; Wittmann, Maria ; Diederichs, Marta ; Nadstawek, Joachim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3604-a7a6297ea5c481c1d67109bbac791805a75aff9bd0e4b8b174958dd4e541123a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Administration, Oral</topic><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory Care - methods</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Delayed-Action Preparations - administration & dosage</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Hydromorphone - administration & dosage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - diagnosis</topic><topic>Neoplasms - drug therapy</topic><topic>Neurology</topic><topic>Pain - diagnosis</topic><topic>Pain - etiology</topic><topic>Pain - prevention & control</topic><topic>Pain Measurement - drug effects</topic><topic>Pneumology</topic><topic>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</topic><topic>Treatment Outcome</topic><topic>Tumors of the respiratory system and mediastinum</topic><topic>Vertebrates: nervous system and sense organs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wirz, Stefan</creatorcontrib><creatorcontrib>Wartenberg, Hans Christian</creatorcontrib><creatorcontrib>Elsen, Christian</creatorcontrib><creatorcontrib>Wittmann, Maria</creatorcontrib><creatorcontrib>Diederichs, Marta</creatorcontrib><creatorcontrib>Nadstawek, Joachim</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Clinical journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wirz, Stefan</au><au>Wartenberg, Hans Christian</au><au>Elsen, Christian</au><au>Wittmann, Maria</au><au>Diederichs, Marta</au><au>Nadstawek, Joachim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Managing Cancer Pain and Symptoms of Outpatients by Rotation to Sustained-release Hydromorphone: A Prospective Clinical Trial</atitle><jtitle>The Clinical journal of pain</jtitle><addtitle>Clin J Pain</addtitle><date>2006-11</date><risdate>2006</risdate><volume>22</volume><issue>9</issue><spage>770</spage><epage>775</epage><pages>770-775</pages><issn>0749-8047</issn><eissn>1536-5409</eissn><coden>CJPAEU</coden><abstract>PURPOSEIn this prospective clinical trial we examined the technique of opioid rotation to oral sustained-release hydromorphone for controlling pain and symptoms in outpatients with cancer pain.
METHODSBefore and after rotation, 50 patients were assessed by Numerical Analog Scales [Numerical Rating Scales (NRS)], or as categorical parameters, and analyzed by descriptive and confirmatory statistics (ANOVA, Wilcoxon, χ).
RESULTSRotation was successful in 64% of patients experiencing pain (60%), and gastrointestinal (32%) and central (26%) symptoms under oral morphine (38%), transdermal fentanyl (22%), tramadol (20%), oxycodone (12%), or sublingual buprenorphine (8%). NRS of pain (4.1 to 3.2; P=0.015), gastrointestinal symptoms, especially defecation rates (P=0.04), and incidence of insomnia improved after an increase in morphine-equivalent doses from 108.9 to 137.6 mg/d without modifying concomitant analgesics or coanalgesics.
CONCLUSIONSSwitching the opioid to oral hydromorphone may be a helpful technique to alleviate pain and several symptoms, but it is still not clear to what extent the underlying mechanisms, such as the technique of rotation itself, better dose adjustment, or using a different opioid have an impact.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>17057558</pmid><doi>10.1097/01.ajp.0000210925.33783.4d</doi><tpages>6</tpages></addata></record> |
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| subjects | Administration, Oral Adult Aged Ambulatory Care - methods Analgesics, Opioid - administration & dosage Biological and medical sciences Delayed-Action Preparations - administration & dosage Drug Administration Schedule Female Fundamental and applied biological sciences. Psychology Humans Hydromorphone - administration & dosage Male Medical sciences Middle Aged Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Neoplasms - complications Neoplasms - diagnosis Neoplasms - drug therapy Neurology Pain - diagnosis Pain - etiology Pain - prevention & control Pain Measurement - drug effects Pneumology Somesthesis and somesthetic pathways (proprioception, exteroception, nociception) interoception electrolocation. Sensory receptors Treatment Outcome Tumors of the respiratory system and mediastinum Vertebrates: nervous system and sense organs |
| title | Managing Cancer Pain and Symptoms of Outpatients by Rotation to Sustained-release Hydromorphone: A Prospective Clinical Trial |
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