Comparing Adverse Effects in Around-the-Clock and As-Needed Analgesia
Nausea, vomiting, drowsiness, lack of energy, urinary retention—these are the side effects of analgesic medications that can be enough to derail pain management for cancer patients. A study of 174 patients with bone metastases suggests that around-the-clock (ATC) prescriptions plus as-needed (p.r.n.) drugs and ATC opioids are often responsible for these effects.
A study from the University of California, San Francisco; the University of Nebraska; and the University of Texas Southwestern Medical Center, Dallas, was part of a larger clinical trial that evaluated the effectiveness of the Pro-Self Pain Control Program in 212 patients with cancer.
Four types of analgesic prescriptions were analyzed: no opioids, p.r.n. opioids only, ATC opioids only, or ATC plus p.r.n. opioids. The most common short-acting opioids were acetaminophen/codeine phosphate (Fioricet, Watson) and aceta-minophen/hydrocodone bitartrate (Vi-codin, Abbott). The most common controlled-release (CR) opioids were morphine and transdermal fentanyl CR (Duragesic, PriCara).
Patients kept diaries on pain management and reported on 11 adverse effects, including difficulty concentrating, lack of energy, nausea, vomiting, and sleep problems. They were asked to rate the number of hours per day and the number of days per week during which pain interfered with their mood or activities and to indicate the amount of relief they received from their pain medication in the previous week. Another scale measured the patients’ ability to perform activities of daily living.
The researchers found no significant differences in “pain now,” average pain, worst pain, or length of time in pain among the four groups. However, total scores from pain interference were significantly higher in patients using ATC plus p.r.n. opioids, compared with those using no opioids. The amount of pain relief was significantly lower in patients receiving no opioids than in those receiving p.r.n. opioids only.
The highest prevalence for the most side effects was found in the ATC-only group and in the ATC plus p.r.n. groups. Despite clinical practice guideline recommendations to treat side effects aggressively, the prevalence rates for most analgesic side effects range from 25% to 80°%. The prevalence of all 11 side effects in the two groups ranged between 25% and 83%.
Not surprisingly, a higher opioid dose was a risk factor for many side effects. The dose taken by patients in the ATC plus p.r.n. group was 3.5 times higher than that in the ATC-only group and 17 times higher than that in the p.r.n-only group. buy altace online
It is worth noting that the patients tended to rate side effects as mild to moderate, regardless of the prescription. The researchers suggest that the patients might have become tolerant of some of the side effects or were using strategies to overcome them.
