morphinans and Pain--Intractable

The analgesic efficacy and tolerability of a morphine agonist-antagonist buprenorphine are evaluated. The drug is compared to pentazocin. For this purpose, the drugs were randomly administered to 42 patients suffering from pain caused by advanced cancer. Buprenorphine demonstrated a significantly higher analgesic effect than pentazocin and was better tolerated.

Topics: Buprenorphine; Clinical Trials as Topic; Drug Evaluation; Female; Humans; Male; Morphinans; Neoplasms; Pain, Intractable; Pentazocine

Sublingual tablets of buprenorphine (Temgesic sublingual) were given in a controlled trial of 41 patients for 2804 patient-days. With a mean starting dose of 1.09 mg and a final dose of 1.53 mg buprenorphine daily there was a good pain-relieving effect. The interval between doses was six to eight hours. The trial did not reveal any direct pointers as to tolerance or addictiveness after long-term intake of the drug. Because of its effectiveness and good duration of action, as well as the absence of negative long-term effects, the drug can be recommended in the long-term management of cancer pain.

Topics: Buprenorphine; Clinical Trials as Topic; Drug Evaluation; Humans; Long-Term Care; Morphinans; Neoplasms; Pain, Intractable; Palliative Care

Topics: Adult; Aged; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Female; Humans; Male; Meperidine; Middle Aged; Morphinans; Morphine Derivatives; Neoplasms; Pain, Intractable; Palliative Care

Twenty-eight cancer patients were treated with intramuscular butorphanol tartrate, a new non-narcotic analgesic, for investigating its clinical benefits in controlling cancer pain. Remarkable analgesic effects were observed approximately 30 minutes after administration by the single dose of either 1 or 2 mg of butorphanol. The effects lasted actively for 3 to 4 hours. Tolerance or drug dependency was rarely recognized even in the cases receiving repeated injections of the drug. Adverse effects, such as dizziness, nausea, thirst, numbness of the hands etc, observed in 5 patients were transient and required no medication. The above results may warrant a long-term administration of the drug for controlling varieties of pain in the cancer patients.

Topics: Aged; Butorphanol; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Neoplasms; Pain, Intractable; Time Factors

1 Twenty-seven patients with moderate to severe chronic pain of malignant origin received buprenorphine (0.3 mg) and morphine (10 mg) intramuscularly in a double-blind, single dose within patient study. 2 Efficacy analysis demonstrated no significant differences in the peak analgesic effects or in the time to reach these effects. However, buprenorphine had a significantly longer duration of action than morphine. 3 Sedation was the most frequent unwanted effect with a similar incidence following each treatment. Buprenorphine was associated with a significantly higher incidence, greater severity, earlier onset, and longer duration of dizziness, nausea and vomiting than morphine. 4 Following both treatments there were small but significant decreases in pulse rate, blood pressure, and respiratory rate.

Topics: Adult; Aged; Buprenorphine; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine; Neoplasms; Pain, Intractable; Time Factors

The therapeutic value of buprenorphine was investigated in 31 patients suffering from moderate to severe cancer pain by intramuscular administration at the single doses of 0.2 mg and 0.3 mg in comparison with pentazocine 30 mg. Analgesic effect of buprenorphine 0.3 mg was significantly superior to buprenorphine 0.2 mg and pentazocine 30 mg. The duration of analgesia with buprenorphine was 9 hours at 0.2 mg and 11 hours at 0.3 mg, which were markedly longer than pentazocine's 6 hours. Side effects most commonly observed in the three groups were nausea, vertigo, oral dryness, urinary retention, vomiting, sweating, and headache. The frequency of side effects was 54.8% for buprenorphine 0.2 mg, 50.0% for buprenorphine 0.3 mg and 58.3% for pentazocine 30 mg respectively, indicating no significant difference between the three groups. Blood pressure, heart rate and respiratory rate did not change appreciably, thereby suggesting a little effect of buprenorphine on the respiratory and cardiovascular systems. Buprenorphine was found a useful or extremely useful in 58% at 0.2 mg and 87.5% at 0.3 mg. As the result it was concluded that buprenorphine could be valuable as an analgesic for cancer pain.

Topics: Adolescent; Adult; Aged; Blood Pressure; Buprenorphine; Female; Humans; Male; Middle Aged; Morphinans; Neoplasms; Pain, Intractable; Pentazocine; Pulse; Respiration

Topics: Aged; Aged, 80 and over; Alfentanil; Combined Modality Therapy; Electric Stimulation Therapy; Female; Humans; Intraoperative Care; Laser Therapy; Male; Middle Aged; Morphinans; Pain; Pain Management; Pain, Intractable; Propofol; Rectal Neoplasms; Sigmoid Neoplasms

Topics: Adolescent; Butorphanol; Child; Drug Evaluation; Female; Humans; Infusions, Intravenous; Male; Morphinans; Neoplasms; Pain, Intractable

Topics: Butorphanol; Drug Evaluation; Humans; Morphinans; Neoplasms; Pain, Intractable; Time Factors

The efficacy of continuous subcutaneous infusion of buprenorphine for the treatment of terminal cancer pain was studied. Continuous subcutaneous administration of 4-8 micrograms/kg/day of buprenorphine, examined by the visual analogue scale was revealed to have satisfactory analgesic potency for control of every type of terminal cancer. This therapy can be undertaken by any member of the medical staff because of its safety and simplicity. The indications for this method are almost unlimited when the subcutaneous tissue can absorb the drug at a constant rate. Continuous subcutaneous buprenorphine administration via a portable infusion pump allows patients with severe pain from cancer the opportunity to move about freely.

Topics: Buprenorphine; Humans; Injections, Subcutaneous; Morphinans; Neoplasms; Pain, Intractable

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2-290 mg) or 0.86 mg buprenorphine (range 0.15-7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1-700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 510 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.

Topics: Adult; Aged; Anesthesia, Epidural; Buprenorphine; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Neoplasms; Pain, Intractable

Buprenorphine sublingual tablets (0.2 mg) were investigated in therapy of cancer pain. In 67 patients there was a good analgetic effect in 60%, even in those cases treated with other opiates before. The induction time was quite long (60 min.) but is no problem in chronic administration. Effective pain relief was obtained even in final stages of cancer. The mean daily dose of buprenorphine had been 1.2-1.7 mg, the mean duration of analgesia being 6-8 hours with a single dose of 0.2-1.0 mg buprenorphine. Typical opiate-side-effects were registered and well tolerated after some days' treatment. There was no respiratory depression. Buprenorphine sublingual tablets are certainly a good alternative in orally available opioids.

Topics: Administration, Oral; Adult; Aged; Buprenorphine; Female; Humans; Long-Term Care; Male; Middle Aged; Morphinans; Neoplasms; Pain, Intractable

Previous to October 1st, 1981, 8 major Danish anaesthesiological departments registered 105 patients treated with extradural opiates for a period of more than 7 days, partially or completely on outpatient basis. Ninety-four suffered from painful malignant diseases and 11 patients from various painful benign diseases. The mean period of treatment was 65 days (range: 7-283 days) and of these 49 days (2-266 days) as outpatients. The total number of inserted epidural catheters was 215, equivalent of an average of 2 per patient (range 1-5). Reasons for removing an extradural catheter were injection-related pain, difficulty in injecting the desired volume, and displacement of catheter. Morphine chloride, in a solution of 0.4 mg/ml of normal saline, was the main choice as analgesic agent (90 patients). The mean daily dose of this drug totalled 12.6 +/- 4.8 mg (S.D.) (range: 4-30 mg) distributed as 2.7 +/- 0.9 (S.D.) (range: 1-6) daily injections. Twelve patients were treated with buprenorphine extradurally. Satisfactory pain relief was achieved for 70 patients (67%) who managed with extradural opiates as sole analgesic treatment. One patient developed septicaemia with a non-fatal outcome probably originating from some other focus. Apart from this no serious side effects were reported. Medically unskilled persons or relatives were responsible for instillation of all extradural opiates with 42 patients and partially responsible with 14 patients. Eleven patients managed injections without assistance. District nurses took care of medication for 46 patients, aided by a general practitioner in 5 cases. Three patients were supplied with continuous extradural infusion by means of a Mill Hill microinfusion pump.

Topics: Ambulatory Care; Analgesia; Buprenorphine; Catheters, Indwelling; Denmark; Epidural Space; Humans; Injections; Morphinans; Morphine; Pain, Intractable

Topics: Buprenorphine; Humans; Morphinans; Neoplasms; Pain, Intractable; Palliative Care; Postoperative Period; Respiration, Artificial

Topics: Butorphanol; Humans; Meperidine; Morphinans; Nursing Care; Pain, Intractable; Pentazocine

Topics: Buprenorphine; Humans; Injections, Intramuscular; Morphinans; Neoplasms; Pain, Intractable