| Variaciones en la respuesta a opioides |
Variations in opioid responsiveness.
Smith HS.
Department of Anesthesiology, Albany Medical College, Albany, NY 12208, USA. smithh@mail.amc.edu
Pain Physician. 2008 Mar-Apr;11(2):237-48.
Abstract
It has been appreciated for some time now that humans react differently to opioids. A specific opioid such as morphine sulfate may have specific analgesic effects for certain patients with postherpetic neuralgia whereas in other patients with postherpetic neuralgia, it may provide quite different analgesic qualities. Also, in any one individual patient a particular opioid may provide better analgesia than other opioids. Furthermore, these differences are not unique to analgesia; they can also be seen with other opioid effects/toxicities. Though many of the differences can be classified neatly into pharmacokinetic and pharmacodynamic differences, there are certain differences which still remain incompletely understood. Also, clinicians are not yet able to easily predict which patients will respond well or poorly to various opioids. As research unravel the various genetics, biochemical, and receptor interaction differences of opioids in humans, it is hoped that easily obtainable, cost-effective testing will become available to aid clinicians in choosing an optimal opioid analgesic for an individual patient, a process which is currently accomplished via health care provider judgment along with trial and error. In the future, knowledge gained from databases on knockout rodents, pharmacogenetics, and gene polymorphisms may impact on the ability of clinicians to predict patient responses to doses of specific opioids in efforts to individualize optimal opioid analgesic therapy. It is conceivable that eventually information of this type may translate into improved patient care. In the future, armed with data of this type, clinicians may become quite adept at tailoring appropriate opioid therapy as well as optimal opioid rotation strategies
http://www.painphysicianjournal.com/2008/march/2008;11;237-248.pdf
|
| Experiencia clínica con opioides administrados transdérmica y oralmente en pacientes de cuidados paliativos-estudio retrospectivo |
Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study.
Clemens KE, Klaschik E.
Department of Science and Research, Centre for Palliative Medicine, University of Bonn, Germany. Katri-Elina.Clemens@malteser.de
Jpn J Clin Oncol. 2007 Apr;37(4):302-9. Epub 2007 May 22.
Abstract
BACKGROUND:
Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients. We thus retrospectively examined the pain management and need for opioid switching in cancer patients admitted to our palliative care unit. METHODS: Of 354 patients admitted to our palliative care unit from 2004 through 2005, 81 patients were pre-treated with transdermal fentanyl. Demographic and cancer-related data (diagnosis, symptoms, pain score on a numeric rating scale (NRS)), analgesic dose at admission and discharge were compared. Statistics: mean +/- SD, ANOVA, Wilcoxon's test was used for inter-group comparisons, significance P < 0.05, adjusted for multiple testing. Pain scores are given in median (range). RESULTS: Mean transdermal fentanyl dose at admission was 81.0 +/- 55.8 microg/h. In 79 patients transdermal fentanyl treatment was discontinued. In two patients, analgesic treatment according to WHO I provided sufficient pain relief. The other 77 patients were switched to other opioids: 33 patients to oral morphine and 44 to oral hydromorphone. In patients switched to morphine the dose at discharge (104.7 +/- 89.0 mg) was lower than at admission (165.5 mg morphine equivalence). In patients switched to hydromorphone the dose of 277.8 +/- 255.0 mg morphine equivalent was higher at discharge than at admission (218.2 +/- 131.4 mg morphine equivalence--considering an equianalgesic conversion ratio morphine: hydromorphone = 7.5: 1). Pain scores decreased significantly after opioid rotation (NRS at rest/on exertion: 4 (0-10)/7 (2-10) versus 1 (0-3)/2 (0-5); P < 0.001). CONCLUSIONS: In the patient group switched to morphine, sufficient pain relief was achieved by lower equianalgesic morphine doses, compared with the doses at admission. In the patient group switched to hydromorphone, higher equianalgesic morphine doses were needed at discharge, considering an equianalgesic conversion ratio of morphine: hydromorphone = 7.5: 1. Patients with far advanced cancer often suffer from sweating and cachexia, which may have negative effects on the absorption of transdermal fentanyl. Opioid switching to oral morphine or hydromorphone was well tolerated and proved to be an efficacious option for cancer pain treatment.
http://jjco.oxfordjournals.org/content/37/4/302.full.pdf+html
|
|
No hay comentarios:
Publicar un comentario