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      The research on long-term clinical effects and patients’ satisfaction of gabapentin combined with oxycontin in treatment of severe cancer pain

      research-article
      , MD a , , MD, PhD a , b , , MD c , , MD a , b
      Medicine
      Wolters Kluwer Health
      average daily cost, cancer pain, gabapentin, life quality, oxycontin

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          Abstract

          Gabapentin has been used as an adjuvant for treatment of cancer pain. Previous studies showed that opioids combined with gabapentin for management of cancer pain reduced the dosage of opioids.

          The objective of this study was to explore the clinical effect and patients’ satisfaction of oxycontin combined with gabapentin in treatment of severe cancer pain. After titration of morphine, 60 severe cancer patients with visual analog score (VAS) more than 7 were randomly divided into trial group (n = 30) and control group (n = 30). The control group was administered oxycontin and placebo, and the trial group was given oxycontin and gabapentin. VAS score was recorded pre- and post-treatment; while daily dose of oxycontin, daily cost of pain relief and life quality score were observed 1 week, 1 month, 2 months, 3 months, and 6 months post-treatment. We found that daily dose of oxycontin 1 month post was comparable between the 2 groups ( P > 0.05). Three months post, compared with control group (58.0 ± 15.2 mg), average daily dose of oxycontin was significant lower in trial group (33.4 ± 11 mg) ( P < 0.001). Average daily cost of pain relief in trail group (34.5 ± 10.2 RMB) was less than the control group (52.4 ± 13.7 RMB) ( P < 0.001). Life quality score increased in all of the patients in both group post-treatment ( P < 0.05); while life quality score in trail group was greater than in control group 3 months (46.8 ± 4.5 vs 43.5 ± 4.6, P = 0.007) and 6 months (46.5 ± 4.8 vs 41.4 ± 4.3, P < 0.001) post-treatment. The incidence of drowsiness and dizziness was comparable between the 2 groups ( P > 0.05), while the incidence of nausea and vomiting ( P = 0.038), and constipation ( P < 0.001) was higher in the control group.

          We concluded that oxycontin combined with gabapentin used in severe cancer pain management can control pain effectively, decreased the dose of oxycontin and the cost of cancer pain relief, and reduced the incidence of nausea and vomiting, and constipation, increased the life quality.

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          Most cited references14

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          A validation study of the WHO method for cancer pain relief.

          The method for cancer pain relief proposed by the World Health Organization (WHO) consists of guidelines for a three-step treatment, from non-opioids to weak and then strong opioids, according to need. Adjuvant drugs can be added to each step. This report presents the 2-year experience of the WHO Collaborating Centre at the National Cancer Institute of Milan in the use of this method. This retrospective study shows that a correct use of the analgesic ladder can reduce pain to a third of its initial intensity. The use of non-opioids had an average duration of 19.2 days; in 52% of the cases treatment was discontinued due to inefficacy and in 42%, to side effects. Weak opioids were administered on an average for 28.0 days. A shift to Strong opioids was made in 92% of the cases due to inefficacy and in 8% because of side effects. Treatment with strong opioids lasted for an average of 46.6 days and can be considered the mainstay of cancer pain therapy. Performance status was not altered considerably during the study and hours of sleep were doubled. The analgesic ladder proved efficacious in 71% of the cases. Neurolytic procedures had to be used in 29%. The authors conclude that analgesics, as proposed by WHO, are the most suitable treatment arm in controlling pain in palliative treatment for advanced cancer patients. Lack of availability or underuse of opioids constitute the real obstacle to the application of this method.
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            Management of cancer pain.

            Patients with cancer have diverse symptoms, impairments in physical and psychological functioning, and other difficulties that can undermine their quality of life. If inadequately controlled, pain can have a profoundly adverse impact on the patient and his or her family. The critical importance of pain management as part of routine cancer care has been forcefully advanced by WHO, international and national professional organisations, and governmental agencies. The prevalence of chronic pain is about 30-50% among patients with cancer who are undergoing active treatment for a solid tumour and 70-90% among those with advanced disease. Prospective surveys indicate that as many as 90% of patients could attain adequate relief with simple drug therapies, but this success rate is not achieved in routine practice. Inadequate management of pain is the result of various issues that include: undertreatment by clinicians with insufficient knowledge of pain assessment and therapy; inappropriate concerns about opioid side-effects and addiction; a tendency to give lower priority to symptom control than to disease management; patients under-reporting of pain and non-compliance with therapy; and impediments to optimum analgesic therapy in the healthcare system. To improve the management of cancer pain, every practitioner involved in the care of these patients must ensure that his or her medical information is current and that patients receive appropriate education.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Opioids for chronic noncancer pain: a new Canadian practice guideline.

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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                October 2016
                21 October 2016
                : 95
                : 42
                : e5144
                Affiliations
                [a ]Department of Anesthesiology
                [b ]Medical Research Center
                [c ]Intensive Care Unit, Shaoxing People's Hospital, Shaoxing, Zhejiang, P.R. China.
                Author notes
                []Correspondence: Yu-Hong Li, Department of Anesthesiology, Medical Research Center, Shaoxing People's Hospital, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang, P.R. China (e-mail: yuh_li@ 123456qq.com ).
                Article
                05144
                10.1097/MD.0000000000005144
                5079328
                27759644
                6b932fdc-ed5a-499a-b18b-2b7bd5827e36
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0, where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 9 September 2016
                : 22 September 2016
                : 26 September 2016
                Categories
                3300
                Research Article
                Observational Study
                Custom metadata
                TRUE

                average daily cost,cancer pain,gabapentin,life quality,oxycontin

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