Concomitant use of strong and weak opiods in management of chronic cancer pain

Abstract

Objectives: Our aim was to search addition of Tramadol to the treatment, when a dose increase is needed; before increasing transdermal fentanyl(TDF) dose in cancer patients using TDF would have any advantages.
Methods: Patients were divided in two groups as ControlGroup(GroupK) and TramadolGroup(GroupT).When patients were first came to polyclinic, demographic data,duration of pain and first VAS values were recorded.Following the first examination, all patients were given TDF containing 25µg/hfentanyl as initial treatment. During study period, TDF dose of patients in GroupK was increased in step of 25µg/h whenever needed. In GroupT, 200mgTramadol was added to treatment whitout increasing TDF dose when a dose increase is needed.In subsequent dose increase requirements in GroupT, TDF dose was sequentially increased 25µg/h when needed without stoping tramadol.Patients VAS score,advers effects were recorded in each polyclinic examination. Patients were asked to asses pain treatment with Treatment Assesment Scale(TAS).Each patient’s participation to the study and highest TDF dose reached were recorded.
Results: The TDS scores measured 1month and 2months after start of study were found similar.However, TAS scores measured at the end of 3rd and 4th months were found significantly higher in GroupT. Mean TDF dose reached at end of the study was found significantly higher in GroupK compared to GroupT.Itching was observed significantly more frequent among patients of GroupK.
Conclusion: We found out in our study, when TDF and Tramadol are use together,TDF need is reduced and pain managment protocol is beter tolerated by patients.Based on results of our study;we suggest concomitant use of strong and weak opioids.