Opioidanalgetika bei “nichtmalignen” Schmerzen—Langzeitbehandlungsergebnisse bei Patienten mit rheumatischen Beschwerden

Abstract

The oral administration of strong opioids like morphine is a very effective treatment in cancer pain. However, these analgesics are rarely prescribed for patients suffering from severe "non-malignant" pain. We examined the effects of oral opioids (morphine sulphate tablets, buprenorphine and levomethadone) given to patients with intractable rheumatic pain, which were refractory to other therapeutic measures. The origin of pain was inflammation or a degenerative lesion of the spine. Within a period of more than 3 years, 12 patients were treated accordingly. In 9 patients we could achieve sufficient pain relief, two of them showing improvement only after having changed the initially prescribed drug. We had to stop opioid medication in two patients because of side-effects and, moreover, in one patient because of failure to produce analgesia. 775 weeks of treatment were documented until December 31th, 1990, with an individual duration ranging from 11 to 145 weeks. It was necessary to increase the dose of morphine in the course of treatment of one patient, who is up to now being treated for more than 77 weeks. In all other patients the doses were either stable or varied. No severe side-effects such as respiratory depression were associated with long-term opioid therapy. Constipation was observed in 4 patients, nausea in two patients and urinary retention in one patient. These side-effects could be well treated by an additional medication. No drug abuse, dependence or tolerance were observed. Strong opioids are not analgesics of first choice in patients with rheumatic disease, but an opioid medication should be considered-as well as in patients with intractable pain caused by another disease-when alternative therapeutic measures have failed. The principles of opioid medication in rheumatic pain are similar to those in patients with cancer pain.

Treatment of Pain With Sustained‐release Tramadol 100, 150, 200 Mg: Results of a Post‐marketing Surveillance Study

“…This successful wide‐scale use of tramadol was confirmed in 1996 when the World Health Organisation recommended it as a step II analgesic in the treatment of tumour pain 32 . There is a general consensus that the WHO therapy scheme in the treatment of tumour pain should also be extrapolated to the treatment of chronic non‐tumour‐related pain 29,33‐35 . Grünenthal has followed the recommendation of using sustained‐release formulations in the treatment of chronic pain by developing a sustained‐release formulation with the active substance tramadol, Tramal long, in the dosage strengths 100, 150 and 200 mg. Tramal long 100, 150, 200 mg has been approved for the treatment of moderate to severe pain in decentralised European proceedings and is now available in various European countries (registration certificate, data on file).…”

“…32 There is a general consensus that the WHO therapy scheme in the treatment of tumour pain should also be extrapolated to the treatment of chronic non-tumour-related pain. 29 -33…”

Anwendungsmöglichkeiten für Opioide bei chronischem Nichttumorschmerz

“…Bestimmte Warnhinweise, so genannte "red flags" [28], müs-sen zu einer kritischen Überprüfung der Schmerzdiagnose und der Opioidindikation führen (Tabelle 4). Bei wiederholter Verletzung der Vereinbarungen hinsichtlich Rezeptierung, Wiedervorstellungsterminen, der Durchführung komplementärer Therapieverfahren oder "riskanten Verhaltens" wird ein Therapieabbruch gefordert [43,60]. Im Zweifel sollte der behandelnde Arzt eine interdisziplinäre Schmerzkonferenz zu Rate ziehen.…”