Opioid combination.

Abstract

The combination of long-acting opioids has not been sufficiently documented in the literature. Patient J.L., aged 67, with disseminated malignant process. Complaints of pelvic and visceral pain. Treatment: sustained release morphine 60 mg/daily. There occurred a need to increase the dose of the drug up to 120 mg/daily; the patient was referred to the Pain Management Outpatient Department. Nociceptive pain was diagnosed at the intensity of 7.5 on the VAS scale. Ketoprofen was included in the treatment at a dose of 200 mg/daily. After three days the morphine dose was increased to 180 mg/daily. Due to the lack of adequate pain control sustained release oxycodone was started, initially at a dose of 20 mg/ daily, and after three days 40 mg/daily. After two weeks, the dose of morphine was decreased to 140 mg/daily. Adequate pain control was obtained.K Ke ey y w wo or rd ds s: : opioid, morphine, oxycodone, opioid combination, pain management. Efficient management of pain in the course of cancer diseases often encounters serious difficulties [1,2]. A very frequent problem is, e.g. concomitant occurrence of many types of pain in the same patient. The course of the disease is often complicated by persistent post-surgical pain, pain related to bone metastases, neurogenic pain, or various types of neuropathic pain due to the infiltration of nerves, post-herpetic neuralgia, or chemotherapy-induced peripheral neuropathy. Unfortunately, very frequently there also occurs a lack of effectiveness of opioids, or a rapid increase in tolerance to the therapy applied.The principles of pain management, coded in the form of the WHO analgesic ladder, on assumption, introduce the principle of combining various drugs in order to increase their effectiveness, due to the use of combining and synergistic mechanisms [3]. Multimodal therapy in the form of opioids, non-steroid antiinflammatory drugs (NSAIDs) and co-analgesics, in the majority of cases allows efficient analgesia to be achieved, without the necessity for increasing the dosage of drugs, and often allows reduction of the amount of drugs applied.Simultaneous application of NSAIDs, opioids and co-analgesics, therefore, is the rule [4]; however, the administration of several drugs of the opioids group still evokes controversy. To date, few reports are available concerning the implementation of such a method of treatment [5]; therefore, it cannot be considered that there is scientific evidence which would justify such models of therapy [6]. At present, one can only rely on the opinion of experts that considering the variation in opioid receptors and varied susceptibility to exogenous ligands used, it is permissible to combine opioid drugs [5,6]. Case reportPatient J.L., aged 67, with endometrial cancer detected at the terminal stage. The patient was in a relatively good condition, in full possession of her faculties, running a household together with her daughter, totally independent. The complaints had started three months earlier, with intensifying pain in the pelvic bone radiating ...