Abstract Details

Title Opioid Responsiveness of Nociceptive Versus Mixed Pain in Clinical Cancer Patients

Topic Neuro-oncology

Presentation(s) S35 - (-)

Poster/Presentation
Number 005

Objective

Background Pain is common in advanced cancer patients. Pain driven by neuropathic mechanisms is generally considered to be resistant to opioids. This hypothesis is based on animal studies and previous single-dose opioid studies in humans.

Design/Methods Clinical data were retrospectively collected from a patient cohort of 230 inpatient cancer pain patients using opioids. Outcome measures were opioid equianalgesic dose, numerical rating scales (NRS) of present pain intensity and Edmonton Symptom Assessment System (ESAS).

Results The median equianalgesic opioid dose was 40 (range 0-240mg) in patients with nociceptive pain and 40 (range 0-280mg) in mixed pain patients (p=0.39; Wilcoxon rank-sum test). Present pain intensity at T=intake was 5.1±2.6 (mean±SD) in patients with nociceptive pain and 6.5±2.0 in patients with mixed pain, at T=3 days after intake 3.8±2.3 versus 3.7±1.6 and at T=discharge 3.0±1.9 versus 3.1±1.8 (p<0.001, source time point; p=0.211, source type of pain; repeated measures ANOVA). Proportions of mild, moderate and severe pain at T=intake, T=3 days and at T=discharge were similar in patients with nociceptive and mixed pain (p =0.644; X2-test). Patients with mixed pain used adjuvant analgesics significantly more often (p=0.001, t-test). ESAS symptoms were significantly different between the two types of pain (p<0.01; MANOVA); nausea, vomiting and shortness of breath may be more prevalent in nociceptive pain patients.

Conclusions We found no significant differences in equianalgesic doses and present pain intensity between patients with purely nociceptive versus mixed cancer pain. A potentially higher prevalence of nausea and vomiting in nociceptive pain patients may represent a higher proportion of patients with gastrointestinal cancer in this group. We conclude that, at least in clinical cancer patients, there is no evidence for opioid resistance in pain driven by neuropathic mechanisms.

Authors/Disclosures
Joost Jongen, MD, PhD PRESENTER	No disclosure on file
Ines Gonzalez	No disclosure on file
	No disclosure on file
	No disclosure on file

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