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Durogesic treatment of advanced cancer pain and quality of life analysis of the clinical efficacy_1448

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Durogesic treatment of advanced cancer pain and quality of life analysis of the clinical efficacy_1448

    Durogesic treatment of advanced cancer pain and quality of life analysis of the clinical efficacy

     Author: Zou Bing Xin, Huang Zuo-ping, XIE

    Qiang, Zhao Dang, Wang Kan

     Abstract Objective To investigate the Durogesic and MS

    Contin treatment of moderate to severe cancer pain, the efficacy and quality of life. Methods 126 patients with moderate to severe cancer pain were randomly divided into two groups, were treated Durogesic (A group) and MS Contin (B) treatment, and record its efficacy, side effects and quality of life. Results Durogesic with MS Contin for pain relief rates were 88.89%, 87.30%, pain relief and quality of life was no significant difference (P> 0.05). Transdermal fentanyl group, nausea, constipation, the incidence of side effects was lower than MS Contin (P <0.01). Conclusion Durogesic the treatment of moderate to severe cancer pain of the safe, reliable, side effects of drugs.

     Key words Durogesic; MS Contin; cancer pain

     The Analysis of Clinic Effects and Quality of Life in the Treatment for Moderate to Sever Cancer Pain

     The Third Department of Internal Medicine, Guangdong Provincial Corp Hospital of Chinese Peoples Armed Police Force, Guangzhou 510507, ChinaAbstract: Objective To

    investigate the efficacy, side effects and quality of life between transdermal fentanyl plaster (Durogesic) and sustained release morphine tablet (MS Contin) in the treatment for

    moderate to sever cancer pain. Methods 126 patients were randomized into Durogesic group (group A) and MS Contin

    group (group B). The two groups received Durogesic and MS

    contin respectively. Then the efficacy, side effects and quality of life were recorded. Results The difference of the effective rates and quality of life of Durogesic and MS

    Contin were not significant. However, the incidence of vomit and constipation were significantly higher in the MS Contin

    group than that of in the Durogesic group. Conclusion The Durogesic is a drug that is safe, reliable and has little side

    effect in treating moderate to sever cancer pain.

     Key words: Durogesic; MS Contin; Cancer pain

     0 Introduction

     From April 2004 our hospital has 126 patients with advanced cancer pain patients were randomly divided into two groups in order to Durogesic (transdermal fentanyl system), scientific name: Fentanyl Transdermal System (Xi'an Janssen Pharmaceutical Co., Ltd. production) outside the paste (A group) and MS Contin oral (B) treatment, now its analgesic effect and adverse reaction reports are as follows:

     1 Data and methods

     1.1 Case Selection

     126 cases of patients with selected undergraduate, male 75 cases, female 51 cases. All these proved to be malignant by pathology, and accompanied by moderate and severe pain. 47

    patients with moderate pain, severe pain in 79 cases. Of these, 43 cases of lung cancer, 7 cases of gastric cancer, liver in 47 cases, 11 cases of esophageal cancer, pancreatic cancer, 3 cases of gallbladder carcinoma, 2 cases of colon cancer in 13 cases. Patients were randomly divided into A group and B group, A group of age (64.5 ? 9.1) years, 53

    cases were male and 20 female; B group (61.9 ? 8.7) years, 46

    cases were male and female 17 cases. No difference between the two groups of information.

     1.2 Treatment

     A group of multi-Rigi externally bonded, multi-drug Regis

    principles: (1) untreated doses to determine: past without the use of too strong opioids in patients with moderate pain in patients given 2.5 mg (the release of fentanyl per hour 25μg)

    began to moderate or severe pain and began to give 5mg; used strong opioids in patients, dose conversion formula [Durogesic an hour to release the dose (μg) = daily oral morphine dose

    (mg) × 1 / 2] conversion. Transdermal fentanyl in the paste,

    while the last use of controlled-release morphine (fentanyl

    slow onset); or the use Durogesic the first 12h, to continue the original amount of morphine that is released, foil every 3 days to replace a sub - . (2) Multi-Regis Usage: Durogesic

    paste parts of the trunk or upper arm should be hair-free,

    flat area, clean and dry skin (can not use soap, oils, or detergents) will affect its absorption of drugs. (3) The paste will make sure that medical membrane formation, a little push, full contact with the skin, the replacement patch, the

    attention to changing positions, and to avoid the accumulation of fentanyl. Replaced once every 3 days, while adjusting doses to keep patients pain-free or almost painless to 24h were

    observed for 15 days for a course of treatment. B group were

    given oral administration of MS Contin, initially given oral MS Contin 30mg/12h, can not be completely pain, the oral administration of MS Contin to increase the amount of 60mg/12h. Adjust the dose so that patients achieve pain-free

    or basic painless 24h were observed for 15 days as a course of treatment.

     1.3 Clinical evaluation

     1.3.1 pain intensity rating

     Split method using visual analogue (VAS): 1 ~ 3 for mild pain; 4 to 6 as moderate pain; 7 to 10 was severe pain.

     1.3.2 determine the effect of

     In the 15 days of pain medication to alleviate

    Evaluation: 0 degrees, the pain did not ease; ?, pain relieve

    1 / 4; ?, pain relieve 1 / 2; ?, pain relieve 3 / 4; ?,

    pain disappear. Pain relief pain relief rate refers to the

    grade ? or the ratio of the total cases. Reposted elsewhere in the paper for free download http://

     1.3.3 Adverse reactions to determine

     Determined according to WHO standards.

     1.3.4 Evaluation of functional status

     According to QLQ C30 scoring to rate [1].

     1.4 Statistical analysis

     To compare the efficacy and toxicity of the rank sum test u test the quality of life comparison (points) with ? s said

    that all the data analysis in statistical software on

    SPSS11.0.

     2 Results

     2.1 A group of analgesic efficacy of

     Complete remission in 14 cases, 30 cases of apparent ease, moderate ease in 12 cases, mild to ease in 4 cases, non-

    remission in 3 cases, with a total effective rate was 88.89%.

    The analgesic efficacy of B group: 12 cases of complete remission significantly ease the 33 cases, 10 patients with moderate ease, mild easing in 5 cases, non-remission in 3

    cases, efficiency of 87.30%. As the sample more, so using u test (u = 0.0266, P = 0.8705). Two groups the difference was not statistically significant.

     2.2 A, B groups before and after treatment compared quality of life

     Table 1. Table 1 A, B groups after treatment to assess, quantitatively measure the quality of life comparison

    (omitted)

     2.3 Observation of adverse reaction

     Table 2. Table 2 A, B two treatment programs for cancer pain in patients with toxic side effect (omitted)

     3 Discussion

     Pain is a common symptoms of cancer, good analgesia can

    not only improve the quality of life of patients, but also to improve treatment compliance.

     Transdermal fentanyl is currently the only opioid used in transdermal agents, the main component of citrate. Fentanyl

    and morphine, the same as the M receptor agonist, analgesic effect of morphine in 75 ~ 100 times its molecular weight is small, fat-soluble good and irritation for transdermal delivery, the initial drug 6 ~ 12 hours reach peak plasma

    concentrations of 12 to 24 hours up to a stable blood concentration, the replacement once every 72 hours, the same dose of drugs, we can maintain a stable blood concentration, Persoli Gudelj M et al [2] that the administration is more convenient 24-hour continuous intravenous administration of non-means [1].

     Durogesic medication is part of the skin surface, drug absorption from the digestive tract pH, and food, drugs in the intestines move, moving time and other complex factors, to avoid the drug in the liver first-pass effect. Particularly

    suitable for gastrointestinal symptoms are more difficult for patients with oral drugs. In the efficacy and side effects, our results and Wang Guangsheng, James Ding, etc. [3,4] report similar to. Radbruch L investigated 994 cases of cancer

    patients found that the use of fentanyl skin permeability of fentanyl doses are safe and reliable treatment of cancer pain drug [5], another study showed that the use of Fentanyl Transdermal Treatment of Pain The inpatient treatment than the

    general non-use of fentanyl pain patients discharged from hospital earlier [6]. Although foreign reports of fentanyl can cause cognitive impairment and affect the patient's lung ventilation [7], but we did not find in the course of these side effects.

     References

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     [2] Persoli Gudelj M. Treatment of pain with opioid

analgesics and the role of TTS fentanyl (Durogesic) [J].

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     [3] Wang Guangsheng, Li-Jian Sun, Ren Xiaojing, et al.

    Durogesic with MS Contin treatment of moderate to severe pain efficacy and cost analysis [J]. Chinese Cancer, 2004,13 (7): 451 453.

     [4] Ding J, Zhuang Jian-sheng, Lin Xinmin, et al.

    Durogesic treatment of 42 patients with moderate or severe cancer pain [J]. Cancer Research, 2003,30 (5): 411 412.

     [5] Radbruch L, Sabatowski R, Petzke F, et al. Transder

     mal fentanyl for the management of cancer pain: a survey of 1005 patients [J]. Palliat Med, 2001,15 (4): 309 321.

     [6] Loughlin JE, Cole JA, Dodd SL, et al. Comparison of resource utilization by patients treated with transdermal fentanyl and long acting oral opioids for nonmalignant pain [J]. Pain Med, 2002,3 (1): 47 55.

     [7] Kornick CA, Santiago Palma J, Moryl N, et al.

    Benefit risk assessment of transdermal fentanyl for the treatment of chronic pain [J]. Drug Saf, 2003,26 (13): 951

    973. Reposted elsewhere free papers on the Download Center http://

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