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      • Record: found
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      The combined analgesic effect of pregabalin and morphine in the treatment of pancreatic cancer pain, a retrospective study

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          Abstract

          Background

          Pregabalin is commonly used to relieve neuropathic pain. However, data are lacking on its efficacy for the treatment of chronic cancer pain. The purpose of this study was to determine the analgesic efficacy of pregabalin combined with morphine in the management of pancreatic cancer pain.

          Methods

          This study reviewed patients who were prescribed morphine and 150 mg/d pregabalin between 1 January 2017 and 10 November 2018 in our institute. The primary outcomes of this study were the average pain score and dose of morphine. Secondary outcomes included characters of breakthrough cancer pain, functional interference related to pain, anxiety/depression status, and incidence of treatment‐related adverse events during the study.

          Results

          A total of 240 patients with pain related to pancreatic cancer were included in the study. The results showed that patients of both combination therapy group (pregabalin+morphine) and monotherapy group (morphine) achieved similar analgesic efficacy, demonstrated by NRS (2.4 ± 0.9 vs. 2.6 ± 0.9; combination vs. monotherapy) at the end of the study. Mean daily dose of morphine used in the combination group was significant lower compared to monotherapy group (39.5 ± 16.0 mg vs. 61.5 ± 19.3 mg, net difference 23.5, 95% CI: 18.4–28.6, p <  0.001). The change of functional interference score related to pain was significantly different between combination and monotherapy group (12.0 ± 0.4 vs. 9.8 ± 4.9; net difference, 2.3; 95% CI: 1.1–3.3; p < 0.001). Patients in combination therapy group had experienced shorter duration of breakthrough cancer pain than those in monotherapy group (X 2 p < 0.001, Cramer's V:0.36). The incidence of somnolence, dizziness, and cognitive dysfunction were significantly higher in the combination group compared to monotherapy group. No serious treatment‐related side effects were observed.

          Conclusions

          The findings of this study supported the use of pregabalin with morphine to relieve pain in patients of pancreatic cancer.

          Abstract

          Cancer related pain is difficult to manage and caused significant lower quality of life in pancreatic cancer patients. Pregabalin has been widely used for the management of neuropathic pain including cancer related neuropathic pain. This study demonstrates that pregabalin and morphine combination achieved satisfactory analgesic effect with significant lower dose of morphine compared to morphine treatment alone. The finding of this study provides evidence for using pregabalin with morphine in the palliative treatment of pancreatic cancer pain.

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          Most cited references28

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          Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review.

          Marianne Jensen Hjermstad, Peter M. Fayers, Dagny Haugen … (2011)
          The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was performed as part of the work of the European Palliative Care Research Collaborative on pain assessment. To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs. A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria. Fifty-four of 239 papers were included. Postoperative PI was most frequently studied; six studies were in cancer. Eight versions of the NRS (NRS-6 to NRS-101) were used in 37 studies; a total of 41 NRSs were tested. Twenty-four different descriptors (15 for the NRSs) were used to anchor the extremes. When compared with the VAS and VRS, NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS. Twenty-nine studies gave no preference. Many studies showed wide distributions of NRS scores within each category of the VRSs. Overall, NRS and VAS scores corresponded, with a few exceptions of systematically higher VAS scores. NRSs are applicable for unidimensional assessment of PI in most settings. Whether the variability in anchors and response options directly influences the numerical scores needs to be empirically tested. This will aid in the work toward a consensus-based, standardized measure. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
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            Prevalence of pain in patients with cancer: a systematic review of the past 40 years.

            M.H.J. van den Beuken-van Everdingen, J.M. de Rijke, A.G. Kessels … (2007)
            Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer. A systematic review of the literature was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodologically acceptable articles were used in the meta-analyses. Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: (i) studies including patients after curative treatment, 33% [95% confidence interval (CI) 21% to 46%]; (ii) studies including patients under anticancer treatment: 59% (CI 44% to 73%); (iii) studies including patients characterised as advanced/metastatic/terminal disease, 64% (CI 58% to 69%) and (iii) studies including patients at all disease stages, 53% (CI 43% to 63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was >50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51% to 88%). Despite the clear World Health Organisation recommendations, cancer pain still is a major problem.
            Article 0 comments Cited 191 times – based on 0 reviews     Review now
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              Neuropathic pain: principles of diagnosis and treatment.

              Ian Gilron, Ralf Baron, Troels Jensen (2015)
              Neuropathic pain is caused by disease or injury of the nervous system and includes various chronic conditions that, together, affect up to 8% of the population. A substantial body of neuropathic pain research points to several important contributory mechanisms including aberrant ectopic activity in nociceptive nerves, peripheral and central sensitization, impaired inhibitory modulation, and pathological activation of microglia. Clinical evaluation of neuropathic pain requires a thorough history and physical examination to identify characteristic signs and symptoms. In many cases, other laboratory investigations and clinical neurophysiological testing may help identify the underlying etiology and guide treatment selection. Available treatments essentially provide only symptomatic relief and may include nonpharmacological, pharmacological, and interventional therapies. Most extensive evidence is available for pharmacological treatment, and currently recommended first-line treatments include antidepressants (tricyclic agents and serotonin-norepinephrine reuptake inhibitors) and anticonvulsants (gabapentin and pregabalin). Individualized multidisciplinary patient care is facilitated by careful consideration of pain-related disability (eg, depression and occupational dysfunction) as well as patient education; repeat follow-up and strategic referral to appropriate medical/surgical subspecialties; and physical and psychological therapies. In the near future, continued preclinical and clinical research and development are expected to lead to further advancements in the diagnosis and treatment of neuropathic pain.
              Article 0 comments Cited 171 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Huichao Zou:
                ORCID: https://orcid.org/0000-0002-8976-0262
                zouhuichao@163.com
                Journal
                Journal ID (nlm-ta): Cancer Med
                Journal ID (iso-abbrev): Cancer Med
                Journal ID (doi): 10.1002/(ISSN)2045-7634
                Journal ID (publisher-id): CAM4
                Title: Cancer Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2045-7634
                Publication date (Electronic): 16 February 2021
                Publication date Collection: March 2021
                Volume: 10
                Issue: 5 ( doiID: 10.1002/cam4.v10.5 )
                Pages: 1738-1744
                Affiliations
                [ 1 ] Department of Pain Medicine Harbin Medical University Cancer Hospital Harbin China
                Author notes
                [*] [* ] Correspondence

                Huichao Zou MD, 150 Haping Rd, Harbin, China.

                Email: zouhuichao@ 123456163.com

                Author information
                https://orcid.org/0000-0002-8976-0262
                Article
                Publisher ID: CAM43779
                DOI: 10.1002/cam4.3779
                PMC ID: 7940217
                PubMed ID: 33594813
                SO-VID: 08bd3605-4d4b-47dc-825e-b489b4fe462c
                Copyright © © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 September 2020
                Date revision received : 27 January 2021
                Date accepted : 28 January 2021
                Page count
                Figures: 1, Tables: 6, Pages: 7, Words: 4666
                Funding
                Funded by: Funding of Harbin Scientific‐Technology Bureau
                Award ID: 2016RAQXJ213
                Funded by: Heilongjiang Postdoctoral Research Developmental Funding
                Award ID: LBH‐Q14214
                Categories
                Subject: Original Research
                Subject: Clinical Cancer Research
                Subject: Original Research
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2021
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.9 mode:remove_FC converted:08.03.2021

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: morphine,pancreatic cancer pain,pregabalin
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: morphine, pancreatic cancer pain, pregabalin

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