Opioides en el tratamiento del dolor oncológico: calidad de vida, grado de analgesia y efectos indeseables.

Abstract

Introduction: Pain is one of the most common symptoms described by cancer patients: 50-85% report significant pain and 42% do not receive adequate analgesia. The assessment of analgesia in cancer patients should be based on the binomial analgesia - quality of life, and not only in the quantification of pain, because it provides a one-dimensional view, which ignores the detrimental social and psychological impact in the patient’s environment._x000D_ The main objective of this thesis is to evaluate the quality of life in patients with chronic cancer pain after receiving analgesia, by comparing the results from 3 different routes of administration: epidural, oral and transdermal._x000D_ Material and Methods: Oncologic patients with chronic pain referred to the Pain Unit of the Hospital del Sagrat Cor, which met the inclusion criteria. They were randomly assigned to one of the 3 study groups: Group RSL: treatment with spinal opioids; Group SMLS: treatment with oral opioids, FTD Group: transdermal opioid treatment. _x000D_ We assessed the quality of life (baseline and 60 days), using the WHOQoL-BREF questionnaire consisting of 26 questions encompassed in 4 areas: physical, psychological, social relationships and environment, plus two general evaluation questions. The WHOQoL-BREF produces scores of areas. A higher score correspond better quality of life. _x000D_ We recorded the occurrence and incidence of side effects -at baseline, 30 and 60 days study- and analgesia -pain at rest with the patient awake, pain with movement or patient-activity- by Andersen scale and visual analogue scale (VAS). _x000D_ X2 test was used to test the hypotheses. Statistical significance was set at 95%, ie p = 0.05. We used the comparison of means for paired samples by the t Student test, after comparing the homogeneity of variances by the F of Snedecor. (SPSS 15.0)._x000D_ Results: 105 patients into 3 groups._x000D_ Analgesia: After 60 days all groups have significantly decreased pain intensity: 22 points on average in the RSL group, 21 points on average SMLS group and 22 points on average the FTD group._x000D_ Adverse effects: In group RSL, after 30 days, episodes of vomiting (p = 0.0063), hallucination, disorientation (p = 0.0464) and dizziness (p = 0.0104) were statistically significant. At 60 days, 6 cases of pruritus and 6 hallucination disorientation are statistically significant (p = 0.0464). In group SMLS the 11 episodes of constipation at 30 days reached statistical significance (p = 0.0414). In the FTD group no one adverse effect reached statistical significance, not 30 or 60 days._x000D_ Quality of life improved significantly in each of the study areas in all groups, with the exception of social relations in the area RSL group that, although experiencing improvement, this was not statistically significant. Overall, the FTD group achieved better scores._x000D_ In reviewing the scientific literature we found no studies comparing the three administration routes discussed in this thesis._x000D_ Conclusions: The intensity of pain in cancer patients significantly improved after receiving analgesia and that involved a statistically significant impact on quality of life. And while the three routes of administration studied proved to be valid, transdermal fentanyl is postulated as the analgesic that showed fewer side effects and that impact more on increasing the quality of life of patients.

Date of Award	26 Jul 2010
Original language	Spanish
Supervisor	Arturo Rodriguez De La Serna (Director)