Abstract
Aim: The aim of the present study was the documentation and evaluation of analgesic therapy in patients with multiple myeloma.
Method: As part of a chemotherapy optimisation study, the patients' pain therapy was documented. The severity of pain was recorded using a visual analogue scale (VAS) from 0 (neither pain nor impairment) to 10 (greatest imaginable pain, and very severe impairment). Follow-up examinations took place after 3 days, 1 month and 3 months.
Results: 123 patients (60.9%) of 202 patients with multiple myeloma stage III, were treated with analgesics because of severe pain. The average duration of documentation was 11.6 months. One hundred patients received analgesics orally or transdermally, and 32 of these patients received oral controlled-release hydromorphone (Palladon® retard). The remaining patients received analgesic treatment with bisphosponates i.v. and non-medication measures. Four patients (n = 19) were treated with a transdermal system and 8 patients who received a different analgesic were changed to hydromorphone during the observation period. The mean dosage of hydromorphone was 20 mg twice daily. Starting with equal pain severity (VAS = 8) it was reduced to 0.6 on the 3rd day of treatment with hydromorphone, while the VAS dropped to only 2.2 during transdermal therapy. After 3 months, the average pain severity with hydromorphone reached 0.4 compared to 2.0 with transdermal analgesic therapy. In this observation phase, typical opioid side effects requiring treatment had occurred with 2 patients (4.8%) of the hydromorphone group and with 6 patients (40%) of the transdermal group.
Conclusion: Controlled-release hydromorphone successfully relieves severe pain in patients with multiple myeloma under routine clinical conditions. In comparison with transdermal systems, controlled-release hydromorphone was significantly more efficient and tolerable.
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