Kronik kanser ağrısı tedavisinde kullanılan transdermal fentanilin geriatrik ve erişkin yaş grubunda karşılaştırılması

Amaç: Transdermal fentanil (TDF) günümüzde kronik kanser ağrısının tedavisinde sıklıkla tercih edilen bir ajandır. Biz, çalışmamızda TDF’in analjezik etkinliğini, yan etki sıklığını ve hasta memnuniyetini, erişkin ve geriatrik hasta grubunda karşılaştırmayı hedefledik. Gereç ve Yöntem: Ağrı polikliniğimizde takip edilen hastalar içerisinden kriterlere uyan 181 hastanın verileri (TDF kullanımı ile başlayan 4 aylık dönem) geriye dönük olarak taranarak çalışmaya alındı. Hastalar yaşlarına göre Grup E (Grup Erişkin; 18 ile 65 yaş arası, n=95) ve Grup G (Grup Geriatrik; 65 yaş üstü, n=86) olarak iki gruba ayrıldı. Hastaların demografik özellikleri, kanser türleri, kanser ağrısı çekme süreleri, vizüel analog skala (VAS) skorları, tedavi değerlendirme skalası (TDS) skorları, kullandıkları TDF dozu, belirttikleri yan etkiler ve TDF tedavisi sonlandırılan hasta sayısı kaydedildi. Bulgular: Her iki grupta da TDF kullanımı sonrası ağrı şiddetinde azalma saptandı (p

Comparison of transdermal fentanyl for the management of cancer pain in adults and elders

Objectives: The transdermal fentanyl (TDF) patch has become widely used in the treatment of cancer pain. We aimed to compare the analgesic efficiency, side effects and patient satisfaction of TDF in adult and geriatric patients. Methods: The data of 181 patients who were observed in our pain clinic were included in this retrospective study. There were 95 patients in the adult group (Group A) and 86 patients in the geriatric group (Group G). Demographic data, cancer type, duration of pain, side effects, visual analog scale (VAS) score, treatment assessment scale (TAS) score, TDF dosage, and the number of patients in whom therapy has been terminated were recorded. Results: After the usage of TDF, reduction in pain score was observed in both groups (p<0.001). The TAS score was similar between the groups at the end of the first month, but it was lower in Group G in the following months. Constipation, dry mouth, somnolence, and dyspnea were seen more frequently in Group G. Because of these side effects, the number of patients in whom therapy was terminated was higher in Group G. Conclusion: The TDF patch is a good choice for cancer pain treatment for both adult and geriatric patients. Since it was observed that the incidence of side effects was higher in the geriatric patients, they should be treated more carefully.

___

  • 1. Bonica JJ. Treatment of cancer pain: current status and future needs. In: Field HL, Dubner R, Cervero F, editors. Advanced in pain research and therapy. Vol 9., New York: Raven Press; 1985. p. 589-616.
  • 2. World Health Organization. Cancer pain relief and palliative care:report of a WHO expert commitee. 2nd ed. Geneva: World Health Organization Tecnical Report Series; 1996.
  • 3. Leppert W, Łuczak J. The role of tramadol in cancer pain treatment-a review. Support Care Cancer 2005;13(1):5-17.
  • 4. Ripamonti C, Fagnoni E, Campa T, Brunelli C, De Conno F. Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy. Support Care Cancer 2006;14(5):400-7.
  • 5. van Seventer R, Smit JM, Schipper RM, Wicks MA, Zuurmond WW. Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain. Curr Med Res Opin 2003;19(6):457- 69.
  • 6. WHO, Health of Eldery, Tec. Rep. Series N. 79. Geneva: WHO; 1989.
  • 7. World Health Organization Regional Office for Europe. Better palliative care for older people. Booklet edited by Davies E, Higginson IJ 2004.
  • 8. Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med 2001;17(3):433-56, v-vi.
  • 9. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 2004;20(4):227-39.
  • 10. Clark AJ, Ahmedzai SH, Allan LG, Camacho F, Horbay GL, Richarz U, et al. Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin 2004;20(9):1419-28.
  • 11. Harkins SW, Price DD, Bush FM, Small R. Geriatric pain. In: Wall PD, Melzack M, editors. Textbook of pain. 3rd ed. New York: Churchill Livingstone; 1994. p. 769-84.
  • 12. Robinson CL. Relieving pain in the elderly. Health Prog 2007;88(1):48-53, 70.
  • 13. Yu SY, Sun Y, Zhang HC, Wu YL, Qin SK, Xie GR, et al. Transdermal fentanyl for the management of cancer pain: a survey of 1,664 elderly patients. [Article in Chinese] Zhonghua Yi Xue Za Zhi 2003;83(22):1931-5. [Abstract]
  • 14. Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 2008;8(4):287-313.
  • 15. Caplan R, Southam M. Transdermal drug delivery and its application to pain control. Adv Pain Res Ther 1990;14:233- 40.
  • 16. Rodriguez-Lopez M. Transdermal buprenorphine in the treatment of neuropathic pain. Rev Soc Esp Dolor 2004;11:11-21.
  • 17. Muijsers RB, Wagstaff AJ. Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs 2001;61(15):2289- 307.
  • 18. Mercadante S, Arcuri E. Pharmacological management of cancer pain in the elderly. Drugs Aging 2007;24(9):761-76.
  • 19. Böger RH. Renal impairment: a challenge for opioid treatment? The role of buprenorphine. Palliat Med 2006;20:17-23.
  • 20. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002;50(6 Suppl):205-24.
Ağrı-Cover
  • ISSN: 1300-0012
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2018
  • Yayıncı: Ali Cangül