Nurdan ÜNLÜ, Ayşegül BİLEN, Namigar TURGUT, Aygen TÜRKMEN, ACHMET ALİ

Kanser ağrısında transdermal fentanil kullanımının kognitif fonksiyonlar üzerine etkisi

Amaç: Bu çalışmada, kanser ağrısında transdermal fentanil (TDF) kullanımının kognitif fonksiyonlar üzerine olan etkisinin incelenmesi amaçlandı. Gereç ve Yöntem: Etik kurul ve hasta onamı alınarak daha öncesinde opioid tedavisi almamış 50 kanser ağrılı hasta çalışma kapsamına alındı. Ağrı değerlendirmesi Vizüel Analog Skala (Visual Analogue Scale-VAS), kognitif fonksiyon muayenesi Addenbrook Kognitif Muayenesi gözden geçirilmiş versiyonu (Addenbrookes Cognitive Examination final revised version -ACE-R) ve günlük aktivite düzeyi Doğu Onkoloji Grubu Performans Ölçütü (Eastern Cooperative Oncology Group Per- formance Status -ECOG) ile değerlendirildi, yan etkiler kaydedildi. Hastaların ilk başvurularında algolojik değerlendirmeleri yapıldı ve ACE-R uygulanarak normal kognitif fonksiyon düzeyleri tespit edildi. Olgularda 25 μg/saat TDF ile tedaviye baş- landı, VAS ≤ 2 olacak şekilde tedavilerinin belirli aşamalarında doz artışı yapıldı, 30. günde yeterli analjezik etkinlik sağlan- dıktan sonra ACE-R yeniden uygulandı. Tüm hastalar kendi aralarında, TDF tedavisi öncesi ve sonrası olmak üzere ACE-R toplam skoru ve alt grupları (dikkat-oryantasyon, bellek, akıcılık, dil, görsel-mekansal yetenekler) açısından karşılaştırıldı. Bulgular: Çalışma sonunda tedavi sonrası, öncesi ile karşılaştırıldığında dikkat, oryantasyon, bellek, akıcılık, dil ve ACE-R toplam skorlarında istatistiksel olarak anlamlı artış saptandı. Görsel ve mekansal yeteneklerde ise anlamlı bir değişme görüle- medi. Olguların günlük aktivite düzeyi başlangıca göre değişmedi. Sonuç: Kanser ağrısında TDF kullanımının kognitif fonksiyonlarda bozulma yapmadığı görüldü, hatta bazı kognitif test skorlarında anlamlı düzelme olduğu saptandı. Ağrının olmaması da hastaların yaşam kalitesini artırdı

The cognitive effects of using transdermal fentanyl in cancer pain

Objectives: In this study, we aimed to investigate the effects of using transdermal fentanyl (TDF) on cognitive functions in cancer pain. Methods: After approval and informed consent of patients by the Ethical Committee, fifty patients with cancer pain who had no pre- vious opioid treatments were included in the study. Pain was evaluated with Visual Analogue Scale (VAS) while, cognitive functions were assessed using by Addenbrooke s Cognitive Examination final revised version (ACE-R). In addition, performance was evaluated with Eastern Cooperative Oncology Group Performance Status (ECOG) and adverse reactions were noted. Patient algological evalu- ation was done in the first application and the normal cognitive functions were established using ACE-R. In most cases the treatment began with 25μg/h TDF and, at certain stages of the treatment, the dose was increased so that VAS ≤2. ACE-R was applied again on day 30under sufficient analgesia. All patients were compared using ACE-R total scores and subgroups (attention-orientation, memory, fluency, language, visuospatial abilities) at before and after TDF treatment. Results: At the end of the study, attention-orientation, memory, fluency, language, and ACER total scores showed a statisticall y signi ficant improvement after TDF treatment than before. No signi ficant change was obtained for the visuospatial abilities. No di f- ference was detected in performance status. Conclusion: The use of TDF for the treatment of cancer pain is not associated with impairment in cognitive performance. Even some cognitive test scores demonstrated signi ficant improvement. Our data shows that the absence of pain increased the quality of li fe.

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1. W orld Health Organization. Cancer pain relief and palliative care:report of a WHO expert commitee. 2nd ed. Geneva: World Health Organization Tecnical Report Series; 1996.
2. L eppert W, Łuczak J. The role of tramadol in cancer pain treatment-a review. Support Care Cancer 2005;13(1):5-17.
3. Cherny N. Cancer pain syndromes. In: Melzack R, Wall PD, editors. Handbook of pain management. Edinburg: Churchill Livingstone; 2003. p. 603-39.
4. Bruera E, Chadwick S, Weinlick A, MacDonald N. Delirium and severe sedation in patients with terminal cancer. Cancer Treat Rep 1987;71(7-8):787-8.
5. M assie MJ, Holland JC. The cancer patient with pain: psychiatric complications and their management. Med Clin North Am 1987;71(2):243-58.
6. V eldhuijzen DS, van Wijck AJ, Wille F, Verster JC, Kenemans JL, Kalkman CJ, et al. Effect of chronic nonmalignant pain on highway driving performance. Pain 2006;122(1-2):28-35.
7. K uhajda MC, Thorn BE, Klinger MR, Rubin NJ. The effect of headache pain on attention (encoding) and memory (recognition). Pain 2002;97(3):213-21.
8. Hanks GW, O'Neill WM, Simpson P, Wesnes K. The cognitive and psychomotor effects of opioid analgesics. II. A random- ized controlled trial of single doses of morphine, loraze- pam and placebo in healthy subjects. Eur J Clin Pharmacol 1995;48(6):455-60.
9. S abatowski R, Schwalen S, Rettig K, Herberg KW, Kasper SM, Radbruch L. Driving ability under long-term treatment with transdermal fentanyl. J Pain Symptom Manage 2003;25(1):38-47.
10. Haythornthwaite JA, Menefee LA, Quatrano-Piacentini AL, Pappagallo M. Outcome of chronic opioid therapy for non-cancer pain. J Pain Symptom Manage 1998;15(3):185-94.
11. K amboj SK, Tookman A, Jones L, Curran HV. The effects of immediate-release morphine on cognitive functioning in patients receiving chronic opioid therapy in palliative care. Pain 2005;117(3):388-95.
12. Jamison RN, Schein JR, Vallow S, Ascher S, Vorsanger GJ, Katz NP. Neuropsychological effects of long-term opioid use in chronic pain patients. J Pain Symptom Manage 2003;26(4):913-21.
13. V ainio A, Ollila J, Matikainen E, Rosenberg P, Kalso E. Driving ability in cancer patients receiving long-term morphine analgesia. Lancet 1995;346(8976):667-70.
14. Larsen B, Otto H, Dorscheid E, Larsen R. Effects of long-term opioid therapy on psychomotor function in patients with cancer pain or non-malignant pain. [Article in German] An-aesthesist 1999;48(9):613-24. [Abstract]
15. Bilen A, Ali A, Alkan I, Altan A. Comparison of transdermal fentanyl for the management of cancer pain in adults and elders. Agri 2012;24(3):111-6.