EAPC - ipac

440 EAPC Abstracts
Significantly fewer patients on the pain-adjusted dose received adjunct
analgesics (58.0% vs. 70.5%). More than 50% of patients had time-of-day
fluctuation in pain intensity at start of study (mean 5.6 (midday) – 6.5
(night). At day 7, levels had significantly decreased to mean 2.8 (night,
morning, midday) or mean 2.9 (evening). By the end, more patients on
pain-adjusted dosage showed improved pain relief than those on fixed dose
(73.8% vs. 70.5%). Quality of life improved more than 50% overall. On
final exam, physicians rated fluctuation as “much improved“ or “improved”
for 88.8% of patients on pain-adjusted dosage. 91.7% of physicians rated
HM efficacy and tolerability as “very good“ or “good“. Conclusions: More
than 50% of patients reported time-of-day differences in pain intensity.
Flexible, 2xday HM dosage improved even time-of-day fluctuation in pain
intensity and quality of life; pain levels dropped through pain-adjusted
dosage. * Palladon ® , Mundipharma GmbH.
136 Oral Presentation
Pain 2
Quality of life in patients treated with controlled release dihydrocodeine
and tramadol – results of a prospective, randomized,
cross-over study
Authors: Wojciech Leppert Chair and Department of Palliative
MedicinePoznan University of Medical Sciences POLAND
Mikolaj Majkowicz Department of Quality of Life Research, Gdansk
Medical University Gdansk POLAND
Background: The aim of the study to assess analgesia, side effects and
quality of life (QL) during dihydrocodeine controlled release tablets (DHC
Continus ® 60, 90, 120 mg) and tramadol controlled release tablets
(Tramundin ® 100 mg, Tramal Retard ® 100, 150, 200 mg) administration to
patients with cancer pain Methods: Prospective, 30 opioid – naive patients
with moderate to severe cancer pain intensity of nociceptive (visceral or
somatic) type treated with non-opioid analgesics, randomised, cross–over,
7 days each no wash – out. Visceral pain 14 patients, bone 10 and mixed 6.
Pain intensity: 24 patients moderate (NRS 3 – 5), 6 severe (NRS > 5).
Analgesia by NRS (Brief Pain Inventory – Short Form), side effects verbal
scale, ESAS, QL by EORTC QLQ C 30. Starting initial dose DHC 2x60
mg, titrated 2x90,2x120 up to 2x180 or 3x120, tramadol 2x100 mg, titrated
2x150, 2x200 up to 2x300 or 3 x 200. Changing drugs – equianalgesic
doses (tramadol = DHC): 2x100 = 2x60, 2x150 = 2x90, 2x200 = 2x120,
2x300 = 2x180. Results: Significant pain relief in both groups but analgesia
significantly superior in DHC group and there was less nausea and less
dyspnoea. Constipation and drowsiness significantly more intense in DHC
group. Global QL better in DHC group. In both groups side effects did not
caused cessation of the treatment and respiratory depression not observed.
Conclusions: 1. Dihydrocodeine and tramadol in controlled release tablets
are effective analgesics in the treatment of nociceptive cancer pain of moderate
intensity but DHC provided significantly better analgesia. 2. Quality
of life results showed better analgesia and global QL in DHC group and
more intense nausea, less drowsiness and less constipation in tramadol
group. The tolerance of the treatment was good in both groups with no serious
side effects like respiratory depression or allergy for the drug. 3. The
second step of the WHO analgesic ladder is important for the treatment of
patients with nociceptive cancer pain of moderate intensity.
137 Oral Presentation
Pain 2
A randomised, double-blind, placebo-controlled, parallel-group
study comparing oral racemic ketamine and S ketamine in the
treatment of cancer-related neuropathic pain
Authors: Marie Fallon Palliative Medicine University of Edinburgh
UNITED KINGDOM
Caroline Bray Beatson Oncology Centre Glasgow UNITED KINGDOM
Angela Boyd University of Edinburgh Edinburgh UNITED KINGDOM
Terry Nichols Napp Pharmaceuticals Ltd (now Mundipharma Research
Ltd) Cambridge UNITED KINGDOM
Lesley Colvin University of Edinburgh Edinburgh UNITED KINGDOM
AJ Miller Napp Pharmaceuticals Ltd Cambridge UNITED KINGDOM
O’Brien Cathy Fincham Statistics Fincham UNITED KINGDOM
Barry Laird University of Edinburgh Edinburgh UNITED KINGDOM
Background: Neuropathic cancer pain remains a clinical challenge. The S-
enantiomer of the NMDA receptor antagonist ketamine may provide analgesia
with a greater potency than racemic ketamine with fewer excitatory
side effects. This study evaluated the efficacy and tolerability of oral solutions
of S-ketamine, racemic ketamine, and placebo in moderate to severe,
cancer-related, neuropathic pain. Methods: A multi-centre randomised controlled
trial which recruited patients from hospitals and hospices in the UK.
Inclusion criteria: moderate to severe, cancer related neuropathic pain,
despite treatment with a strong opioid for moderate to severe pain. The
study consisted of a titration period of up to seven days, followed by a two
day assessment period. The primary efficacy variable was pain intensity
which was assessed using the Box-11 pain score. Other efficacy measures
included the Brief Pain Inventory (BPI) and short-form McGill Pain
Questionnaire(MPQ). Results: 65 patients were recruited with 22 (34%)
receiving S-ketamine, 22 (34%) racemic ketamine, and 21 (32%) placebo.
38 patients (84%) completed the study. S-Ketamine, racemic ketamine and
placebo were associated with analgesia and there was no statistically significant
differences between treatment groups in the primary efficacy variable
during the assessment period (ANCOVA morning: P=0.829, midday:
P=0.480, evening: P=0.844). S-ketamine provided the largest reduction in
the MPQ sensory, affective, and total pain intensity scores (total mean pain
intensity scores: 21.9 [SD 8.7] at baseline to 4.9 [SD 6.4] at study endpoint)
but this did not reach statistical significance (sensory pain: P=0.068, affective
pain: P=0.316, and total pain P=0.073). Conclusions: Based on the primary
efficacy variable, the analgesic effects of ketamine and S-ketamine
were not statistically significant from placebo. Beneficial trends were
observed in the MPQ sensory descriptors. A much larger trial would be
required to show statistical significance.
138 Oral Presentation
Pain 2
Can gradual dose titration of ketamine prevent psychotomimetic
effects of advanced cancer patients with neuropathic
pain
Authors: Yoshiaki Okamoto Graduate School of Pharmaceutical Science
Osaka University JAPAN
Yumiko Ono Osaka University Suita Osaka JAPAN
Soitiro Yasuda Osaka University Suita Osaka JAPAN
Keiko Tazumi Osaka University Suita Osaka JAPAN
Satoru Tsuneto Osaka University Suita/Osaka JAPAN
Sho Goya Osaka University Suita Osaka JAPAN
Hitoshi Tanimukai Osaka University Suita Osaka JAPAN
Yoichi Matsuda Osaka University Suita Osaka JAPAN
Hiroshi Eto Osaka University Suita Osaka JAPAN
Yoshie Toya Osaka University Suita Osaka JAPAN
Etsuko Uejima Osaka University Suita Osaka JAPAN
Nobuo Kurokawa Osaka University Suita Osaka JAPAN
Introduction: Ketamine is an N-methyl-D-aspartate receptor antagonist
and is used to treat neuropathic cancer pain. However, it may cause psychotomimetic
effects such as nightmares, illusions, hallucination, or delirium.
We examined the effectiveness and safety of gradual dose titration of
ketamine in the treatment of neuropathic pain in advanced cancer patients
prospectively. Methods: After we diagnosed neuropathic pain, which did
not respond to opioids in advanced cancer patients, we started ketamine
10mg/24hr by continuous intravenous infusion and increased the dose by
10mg/24hr every 4–6 hours before the dose exceeded 50mg/24hr. After
50mg/24hr, we increased ketamine by 25mg/24hr every 12–24 hours until
pain was relieved. Results: There were 15 men (62.5%) and 9 women
(37.5%), with an average age of 49.2years (SD=18.4), ranging from 13 to
74 years of age. The patients had a variety of tumors, with rectum cancer