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01-03-2014 | Original Article

Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study

Authors: Angela Maria Sousa, José de Santana Neto, Gabriel M. N. Guimaraes, Giovana M. Cascudo, José Osvaldo B. Neto, Hazem A. Ashmawi

Published in: Supportive Care in Cancer | Issue 3/2014

Abstract

Purpose

The WHO analgesic ladder supports medication choice according to pain intensity. The use of the analgesic ladder in an inverse way, has the advantage of using the same principles of the original ladder to treat crisis of pain in cancer patients. The purpose of this study is to describe the use of intravenous patient-controlled analgesia (IV-PCA) technique in patients admitted to an oncological Hospital.

Methods

This is a case series study. Patients assigned to receive IV-PCA between March 2011 and May 2012 were selected for the study. Medical records were reviewed, patients stratified according to the Karnofsky Performance Score (KPS). The primary outcome was to verify if different IV-PCA opioid solutions could be equally effective providing pain relief. Secondary outcomes were the incidence of clinical side effects that can be associated to IV-PCA infusions.

Results

A total of 95 medical records were reviewed. Most patients used IV-PCA with morphine (42.1 %), fentanyl (42.1 %) or methadone (15.7 %) to treat exacerbation periods of cancer pain. IV-PCA used as supplementary therapy successfully improved pain control in 78.9 % of the patients, without any difference related to opioid solution. KPS <40 was related to higher rate of pain relief, without any difference in side effects in this group of patients. The most common side effects were sedation (10.5 %) followed by constipation (9.4 %) and nausea (4.2 %). Morphine presented a higher risk than fentanyl for sedation. Analgesia-related delirium or respiratory depression were not reported in this case series study.

Conclusions

IV-PCA provided timely, safe and useful analgesia for patients with severe breakthrough pain and may be useful to help titration of opioids, weaning to oral analgesia and to decide for interventional procedures.

INCA (2012). Estimativa 2012: incidência de câncer no Brasil. Tech. rep. Instituto Nacional do Cancer; http://www.inca.gov.br/estimativa/2012

Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433. doi:10.1093/annonc/mdp001 PubMedCrossRef

Caraceni A, Portenoy RK (1999) A working group of the IASP Task Force on Cancer Pain. An International survey of cancer pain characteristics and syndromes. Pain 82:263–274PubMedCrossRef

World Health Organization (1986). Cancer pain relief. World Health Organization; Geneva. http://whqlibdoc.who.int/publications/9241544821.pdf

Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56:514–517PubMedCentralPubMed

Nolan MF, Wilson MC (1995) Patient-controlled analgesia: a method for the controlled self-administration of opioid pain medications. Phys Ther 75:374–379PubMed

Aubrun F, Mazoit J-X, Riou B (2012) Postoperative intravenous morphine titration. Br J Anaesth 108:193–201. doi:10.1093/bja/aer458 PubMedCrossRef

Sardin B, Lecour N, Terrier G, Grouille D (2012) About safety parameters for patient-controlled analgesia (PCA) devices. Ann Fr Anesth Reanim 31:813–817. doi:10.1016/j.annfar PubMedCrossRef

American Society of Anesthesiologists Task Force on Acute Pain Management (2012) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116:248–273. doi:10.1097/ALN CrossRef

10.

Dev R, Del Fabbro E, Bruera E (2011) Patient-controlled analgesia in patients with advanced cancer. Should patients be in control? J Pain Symptom Manage 42:296–300. doi:10.1016/j.jpainsymman PubMedCrossRef

11.

Nassar Junior AP, Pires Neto RC, de Figueiredo WB, Park M (2008) Validity, reliability and applicability of Portuguese versions of sedation–agitation scales among critically ill patients. Sao Paulo Med J 126:215–219PubMedCrossRef

12.

Dahan A, Aarts L, Smith TW (2010) Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology 112:226–238. doi:10.1097/ALN.0b013e3181c38c25 PubMedCrossRef

13.

Ketwaroo GA, Cheng V, Lembo A (2013) Opioid-induced bowel dysfunction. Curr Gastroenterol Rep 15(9):344. doi:10.1007/s11894-013-0344-2 PubMedCrossRef

14.

Bush SH, Bruera E (2009) The assessment and management of delirium in cancer patients. Oncologist 14:1039–1049. doi:10.1634/theoncologist PubMedCrossRef

15.

Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S (2010) On behalf of the European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 149:476–482. doi:10.1016/j.pain.2010.02.035 PubMedCrossRef

16.

Mercadante S, Caraceni A (2011). Conversion ratios for opioid switching in the treatment of cancer pain: a systematic review. Palliat Med. Jul;25(5):504–15. doi: 10.1177/0269216311406577.

17.

R Core Team (2013). R: a language and environment for statistical computing. The R Project for Statistical Computing, Vienna, Austria. (http://www.R-project.org)

18.

Ilias W, lePolain B, Buchser E, Demartini L (2008) Patient-controlled analgesia in chronic pain patients: experience with a new device designed to be used with implanted programmable pumps. Pain Pract 8:164–170. doi:10.1111/j.1533-2500.2008.00187 PubMedCrossRef

19.

Brogan SE, Winter NB (2011) Patient-controlled intrathecal analgesia for the management of breakthrough cancer pain: a retrospective review and commentary. Pain Med 12:1758–1768. doi:10.1111/j.1526-4637.2011.01262 PubMedCrossRef

20.

Kerr IG, Sone M, Deangelis C, Iscoe N, MacKenzie R, Schueller T (1988) Continuous narcotic infusion with patient-controlled analgesia for chronic cancer pain in outpatients. Ann Intern Med 108:554–557PubMedCrossRef

21.

Kim SH, Yoon KB, Yoon DM, Kim CM, Shin YS (2013) Patient-controlled epidural analgesia with ropivacaine and fentanyl: experience with 2,276 surgical patients. Korean J Pain 26:39–45. doi:10.3344 PubMedCentralPubMedCrossRef

22.

Duarte RV, Raphael JH, Haque MS, Southall JL, Ashford RL (2012) A predictive model for intrathecal opioid dose escalation for chronic non-cancer pain. Pain Physician 15:363–369PubMed

23.

Kim SH, Yoon DM, Choi KW, Yoon KB (2013) High-dose daily opioid administration and poor functional status intensify local anesthetic injection pain in Cancer Patients. Pain Physician 16:E247–E256PubMed

24.

Grass JA (2005) Patient-controlled analgesia. Anesth Analg 101:S44–61PubMedCrossRef

25.

Craft J (2010) Patient-controlled analgesia: is it worth the painful prescribing process? Proc (Bayl Univ Med Cent) 23:434–438

26.

SFAP (2006). Groupe de travail sur l'utilisation de la PCA pour l'administration de morphine en soins palliatifs –Société Française d'Accompagnement et de Soins Palliatifs. http://www.em-consulte.com/article/97684/figures/recommandations-pour-l-indication-et-l-utilisation

27.

Lux EA, Heine J (2011) Home care treatment of cancer pain patients with patient-controlled analgesia (PCA). Schmerz 25:663–667. doi:10.1007/s00482 PubMedCrossRef

28.

Schiessl C, Bidmon R, Sittl R, Grießinger N, Schüttler J (2007) Patient-controlled analgesia (PCA) in outpatients with cancer pain. Analysis of 1,692 treatment days. Schmerz 21:35–42PubMedCrossRef

29.

Schiessl C, Sittl R, Griessinger N, Lutter N, Schuettler J (2008) Intravenous morphine consumption in outpatients with cancer during their last week of life—an analysis based on patient-controlled analgesia data. Support Care Cancer 16:917–923PubMedCrossRef

30.

Schiessl C, Gravou C, Zernikow B, Sittl R, Griessinger N (2008) Use of patient-controlled analgesia for pain control in dying children. Support Care Cancer 16:531–536. doi:10.1007/s00520-008-0408-2 PubMedCrossRef

31.

Greco MT, Corli O, Montanari M, Deandrea S, Zagonel V, Apolone G (2011) Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients: results from the Cancer Pain Outcome Research Study Group. Clin J Pain 27:9–18. doi:10.1097/AJP.0b013e3181edc250 PubMedCrossRef

32.

Margarit C, Juliá J, López R, Anton A, Escobar Y, Casas A, Cruz JJ, Galvez R, Mañas A, Zaragozá F (2012) Breakthrough cancer pain – still a challenge. J Pain Res 5:559–566. doi:10.2147/JPR.S36428 PubMedCentralPubMedCrossRef

33.

Santini D, Lanzetta G, Dell'Aquila E, Vincenzi B, Venditti O, Russano M, Papapietro N, Denaro V, Tonini G, Ripamonti C (2013) ‘Old’ and ‘new’ drugs for the treatment of cancer pain. Expert Opin Pharmacother 14:425–433. doi:10.1517/14656566 PubMedCrossRef

34.

Smith HS (2013) Considerations in selecting rapid-onset opioids for the management of breakthrough pain. J Pain Res 6:189–200. doi:10.2147/JPR.S40745 PubMedCentralPubMedCrossRef

35.

Smith H (2012) A comprehensive review of rapid-onset opioids for breakthrough pain. CNS Drugs 26(6):509–535. doi:10.2165/11630580 PubMedCentralPubMedCrossRef

36.

Taylor DR (2013) Single-dose fentanyl sublingual spray for breakthrough cancer pain. Clin Pharmacol 5:131–141. doi:10.2147/CPAA.S26649 PubMedCentralPubMed

37.

Nave R, Schmitt H, Popper L (2013) Faster absorption and higher systemic bioavailability of intranasal fentanyl spray compared to oral transmucosal fentanyl citrate in healthy subjects. Drug Deliv 20:216–223. doi:10.3109/10717544 PubMedCrossRef

38.

Hoskin PJ, Hanks GW, Aherne GW, Chapman D, Littleton P, Filshie J (1989) The bioavailability and pharmacokinetics of morphine after intravenous, oral and buccal administration in healthy volunteers. Br J Clin Pharmacol 27:499–505PubMedCentralPubMedCrossRef

Title: Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study
Authors: Angela Maria Sousa
José de Santana Neto
Gabriel M. N. Guimaraes
Giovana M. Cascudo
José Osvaldo B. Neto
Hazem A. Ashmawi
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 3/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-2036-8

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