Articles of interest in other scholarly journals
Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study
Currow DC, McDonald C, Oaten S, Kenny B, Allcroft P, Frith P, Briffa M, Johnson MJ, Abernethy AP. Journal of Pain and Symptom Management 2010;11.021
In a Phase II dose increment study and a long-term Phase IV effectiveness/safety study the effect of sustained-release oral morphine on dyspnoea was evaluated in 83 patients. Of those patients, 62% derived ≥10% benefit from morphine, in 70% this dose was 10mg/24h. One in three people continued to derive benefit at three months. Ranking of breathlessness was reduced significantly, but constipation increased despite laxatives. There were no episodes of respiratory depression or hospitalisations as a result of the morphine.
Opioid dose and drug-related mortality in patients with nonmalignant pain
Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Arch Intern Med. 2011;171(7):691-693
A population-based nested case-control study of over 600 000 patients receiving opioids over a nearly 10-year period through the Ontario Provincial Drug Program. After adjustment for an array of clinical and demographic factors, it was found that average daily doses of 200 mg or more of morphine (or equivalent), was associated with a nearly 3-fold increase in the risk of opioid-related mortality relative to low daily doses (<20 mg of morphine, or equivalent). Significant increases in opioid-related mortality with intermediate doses of opioids (50-99 mg/d of morphine: OR, 1.92; 100-199 mg/d of morphine: OR, 2.04) was also found. The authors conclude that, in patients receiving opioids for non-malignant pain, the daily dose is strongly associated with opioid-related mortality.
Przeklasa-Muszynska A, Dobrogowski J. Current Medical Research & Opinion.2011; doi:10.1185/03007995.2011.56901
In this prospective, open-label, non-comparative, non-interventional, post-marketing study in Poland, patients with chronic cancer and non-cancer pain, not controlled by non-opioids, were prescribed buprenorphine transdermal patch 35, 52.5 or 70 micrograms/hour, and followed up for 3 months. In over 4000 patients (80.7% had cancer-related pain), the mean pain intensity (using a 100mm visual analogue scale) decreased by 73.5% from 62.3mm at baseline to 16.5mm after 3 months. Most patients rated pain relief as ‘very good’ (41.4%) or ‘good’ (44.5%). 96% rated the buprenorphine transdermal patch as ‘very easy’ or ‘easy’ to change. The most common treatment-related reasons for discontinuation were lack of analgesic effect (3.3% of patients) and adverse drug reactions (0.8%), which were all non-serious, most commonly local skin reactions or vomiting. The authors note the limitation of the observational study design.
Short Cuts by Jason Boland, University of Sheffield, School of Medicine and Biomedical Sciences