International Journal of Medical Laboratory Research (IJMLR)

AUDIT OF EFFICACY AND ADVERSE EVENTS OF ANALGESICS USED TO MITIGATING CANCER PAIN: OBSERVATIONS FROM A TERTIARY CARE HOSPITAL

 

AR Simon, PL Palatty, KR Thilakchand3, T George, S Abraham, S Rao, MS Baliga

 

ABSTRACT:

Introduction: Analgesics are the main stay in the mitigation of pain in cancer patients. However, depending on the type of analgesics, adverse events which at times can be severe are also observed. In this study an attempt has been made to understand the beneficial and adverse effects of the standard analgesics recommended for mitigating cancer pain. Materials and methods: This is a cross sectional prospective observational study with 150 cancer patients requiring analgesics and was conducted at the oncology ward of a tertiary care hospital. The prescription pattern, the mitigation of pain and the adverse events were recorded. Results: The results indicate that morphine injection was the most effective followed by morphine tablets, ultracet, tramadol and paracetamol. With regard to the adverse effects it was observed that 70.7% of the patients had one or other symptoms and that constipation (9.3%; 14/150) followed by nausea (8%; 12/150) and drowsiness (5.3%; 8/150) were the most common. Conclusion: The results of the study indicate that in spite of administering protective/ preventive drugs analgesic-induced adverse effects are common in cancer patients..

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KEY WORDS: Analgesics, cancer, morphine, ultracet, tramadol, paracetamol, WHO three-step ladder, adverse events.

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REFERENCES:

1. Paice JA and Ferrell B. "The Management of Cancer Pain." CA Cancer J Clin. 2011; 157–182.

2. Tavoli A, Montazeri A, Roshan R, Tavoli Z and Melyani M. Depression and quality of life in cancer patients with and without pain: the role of pain beliefs. BMC Cancer 2008:177 https://doi.org/10.1186/1471-2407-8-177

3. Ahles TA, Blanchard EB, Ruckdeschel JC: Multidimensional nature of cancer pain. Pain. 1983, 17: 277-288.

4. Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database Syst Rev. 2016 22; 4:CD003868. doi: 10.1002/14651858.CD003868.pub4. 29.

5. Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F; ESMO Guidelines Working Group. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol. 2012; 23 Suppl 7:vii139-54.

6. World Health Organization (1986). Cancer pain relief (PDF) (1 ed.). Geneva: World Health Organization. ISBN 9241561009.

7. Kawahito S, Soga T, Mita N, Satomi S, Kinoshita H, Arase T, Kondo A, Miki H, Takaishi K, Kitahata H. Successful treatment of mixed (mainly cancer) pain by tramadol preparations. J Med Invest. 2017; 64(3.4):311-312.

8. Liu YC, Wang WS. Human mu-opioid receptor gene A118G polymorphism predicts the efficacy of tramadol/acetaminophen combination tablets (ultracet) in oxaliplatin-induced painful neuropathy. Cancer. 2012; 118(6):1718-25.

9. Pergolizzi JV, van de Laar M, Langford R, et al. Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain. Journal of Pain Research. 2012; 5:327-346.

10. Mercadante S, Prestia G, Ranieri M, Giarratano A, Casuccio A. "Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit." Support Care Cancer. 2013; 21: 1853-9.

11. Glare P, Walsh D, Sheehan D. The Adverse Effects of Morphine: A Prospective Survey of Common Symptoms During Repeated Dosing for Chronic Cancer Pain. Am J Hosp Palliat Care. 2006; 23: 229-235.

12. Wiffen PJ, Derry S, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral paracetamol (acetaminophen) for cancer pain. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012637. DOI: 10.1002/14651858.CD012637.

13. Twycross R, Pace V, Mihalyo M, Wilcock A. Acetaminophen (Paracetamol). Journal of Pain and Symptom Management. 2013; 46 (5): 747-755.

14. Morón Merchante I, Pergolizzi JV, van de Laar M, et al. Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review. ISRN Family Medicine. 2013; 638469. doi:10.5402/2013/638469

15. Edwards JE, McQuay HJ, Moore RA. Combination analgesic efficacy: individual patient data meta-analysis of single-dose oral tramadol plus acetaminophen in acute postoperative pain. J Pain Symptom Manage. 2002; 23(2): 121-30.

16. Shipton EA. "Tramadol--present and future." Anaesthesia and Intensive Care. 2000; 28(4):363-374.