Clinical evaluation of combined treatment with methadone and psychotropic drugs in cancer patients
| Autor: | F. Rennemo, Harald Breivik |
|---|---|
| Předmět: |
Adult
Male Time Factors Nitrazepam Nausea Levomepromazine Neoplasms Humans Medicine Amitriptyline Depression (differential diagnoses) Aged Psychotropic Drugs Morphine business.industry General Medicine Middle Aged Pain Intractable Discontinuation Anesthesiology and Pain Medicine Anesthesia Haloperidol Drug Therapy Combination Female medicine.symptom business Cancer pain Methadone medicine.drug |
| Zdroj: | Scopus-Elsevier |
| Popis: | We reviewed the hospital charts of 111 patients treated with oral methadone for cancer pain during a period of 2½12 years. Fifty-six of these patients, treated with the personal involvement of the authors, were also given haloperidol, levomepromazine, diazepam, amitriptyline or nitrazepam for hallucination, confusion, nausea, overwhelming pain, depression and anxiety, or insomnia. The remaining 55 patients, treated by different ward physicians, did not receive psychotropic drugs. The dose of methadone increased from a mean of 37 mg/day to 113 mg/day in the seven patients who were still being given methadone after seven months. Of the 56 patients given methadone and psychotropic drugs as needed, 80% obtained good pain relief, 16% moderate, and only 4% inadequate pain relief. Nausea or intestinal obstruction caused discontinuation of methadone by mouth in 20% of these patients. Of the 55 patients who did not receive psychotropic drugs, 67% obtained good pain relief, but 33 % did not obtain adequate pain relief. Hallucinations, confusion, nausea or intestinal obstruction caused discontinuation of methadone treatment in 42% of these patients. Less than 20% of these patients were treated for 5 weeks or more, compared to more than 50% of the patients treated with psychotropic drugs in addition to methadone. There was no sign of overdosage from accumulation with prolonged treatment, but tolerance developed slowly. Thus methadone may be administered safely for several months for severe cancer pain. However, psychotropic drugs appear to be necessary to suppress side-effects and to give sufficient pain relief. To obtain satisfactory pain relief, it is also necessary that the doctor and other health personnel treating patients with disseminated cancer and pain have sufficient time, patience and dedication to re-evaluate the patients' problems and adjust treatment frequently. |
| Databáze: | OpenAIRE |
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