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Slavica Lahajnar Institute of Oncology Ljubljana

Choice of Analgesic Appropriate to Pain Intensity PMI in Patients at the Institute of Oncology. Slavica Lahajnar Institute of Oncology Ljubljana. Chronic Pain in Cancer. Around 60-80 % of patients with advanced cancer suffer pain.

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Slavica Lahajnar Institute of Oncology Ljubljana

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  1. Choice of Analgesic Appropriate to Pain Intensity PMI in Patients at the Institute of Oncology Slavica Lahajnar Institute of Oncology Ljubljana

  2. Chronic Pain in Cancer • Around 60-80 % of patients with advanced cancer suffer pain. • Up to 40 % suffer from uncontrolled pain (VAS≥4). • Inappropriate use of opioids may often be the cause of uncontrolled pain. Evendingen MH, Rijke JM, Kessels AG et all. Ann Oncol 2007; 18: 1437-49 Cohen MZ, Easley MK, Ellis C et all. J Pain Symptom Manage 2003; 25: 519-527 Maltoni M. Ann Oncol 2008; 19: 5-7

  3. Pain Management Index (PMI) • Negative PMI: considering pain intensity, the prescribed analgesic is not strong enough. • Metaanalysis of 26 trials (Ann. Oncol. 2008): 43% (8-82%) has negative PMI. • Estimate of the pain management interventions on the basis of good clinical practice (using WHO three-grade pain scale). • Rough estimate of the pain management in general population. Cleeland CS, Gonin R, Hatfield AK et all. N Engl J Med 1994; 330: 592-6 Wit R, Dam F, Loonstra S et all. Pain 2001; 91: 339-349 Deandrea S, Montanari M, Moja L. Ann Oncol 2008; 19: 1985-91

  4. Raziskava na Onkološkem inštitutu A Study Carried Out at the Institute of Oncology • 248 patients’ charts • Negative PMI in patients with uncontrolled pain. • Comparison with a similar study performed in 2005. • Other causes of uncontrolled pain. - prescribed analgesic - patient’s estimate of pain intensity (the 5th vital sign)

  5. A Study Carried Out at the Institute of Oncology 18% 18% 45%

  6. A Study Carried Out at the Institute of Oncology 74% 22%

  7. A Study Carried Out at the Institute of Oncology prescribed analgesic – pain intensity = PMI - = 1 3 - 2 11% 56%

  8. Conclusions (1): In 2009 (in comparison to 2005): Less patients with VAS ≥ 4 (none with VAS ≥ 7). The patients with VAS ≥4 are receiving analgesics (the majority are treated with a strong opioid, noone with nonopioid alone). Less patients are treated with analgesics that are not strong enough considering the pain intensity (neg. PMI). A Study Carried Out at the Institute of Oncology ○ Pain - 5th vital sign Pain Management Recommendations Instructions provided to therapists, nurses and patients

  9. PMI Positive Patients with Uncontrolled Pain • immediate-release opioid for break-through pain • adjuvant agents to relieve side effects of opioids • adjuvant agents and interventions to relieve neuropathic pain prescribed analgesic – pain intensity= PMI - = 3 3 0 • cancer treatment (bone metastases)

  10. A Study Carried Out at the Institute of Oncology Patients under Opioid Treatment

  11. Conclusions (2): Patients with z VAS ≥ 4 are treated with inadequate dose of controlled-release opioid. They do not take “rescue” dose of immediate-release opioid as prescribed Patients with advanced cancer (bone metastases) often suffer uncontrolled pain. A Study Carried out at the Institute of Oncology titration of opioid rotation of strong opioid treatment efficiency follow-up individulized pain management

  12. Thank you for your attention!

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