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Erschienen in: Supportive Care in Cancer 11/2007

01.11.2007 | Short Communiation

Adjunct dipyrone in association with oral morphine for cancer-related pain: the sooner the better

verfasst von: José F. Duarte Souza, Paula P. Lajolo, Hélio Pinczowski, Auro del Giglio

Erschienen in: Supportive Care in Cancer | Ausgabe 11/2007

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Abstract

Introduction

Adjunct nonopioid analgesics may improve pain control in patients with cancer needing morphine or its derivates. Dypirone is a cheap nonopioid analgesic widely used in many countries.

Objective

The objective of the study was to evaluate, whenever morphine was started, if associating dipyrone with it would improve pain control and if this effect was time dependent.

Materials and methods

This is a double-blind placebo-controlled randomized crossover study. Thirty-four ambulatory cancer patients experiencing cancer-related pain for which oral morphine was to be started at the dose of 10 mg orally (PO) every 4 h were randomized to take either dipyrone 500 mg PO every 6 h or placebo. After 48 h, patients would be switched from dipyrone to placebo and vice versa. Pain was the primary outcome and was measured using a visual analogue scale before starting medications, at 48 and 96 h.

Results

We randomized 16 patients to start with placebo (group 1) and 18 with dipyrone (group 2). Pain scores for groups 1 and 2 were at baseline: 7.31 ± 0.29 vs 6.88 ± 0.28 (p = 0.3), at 48 h: 7.06 ± 0.32 vs 5.5 ± 0.31 (p = 0.001), and at 96 h: 3.18 ± 0.39 vs 1.94 ± 0.37 (p = 0.03). Both groups had significant improvements in pain scores after introducing dipyrone (p < 0.001, for both). Main toxicities were nausea, vomiting, epigastric pain, and myalgias. Twenty-eight patients chose dipyrone, four placebo, and two were indifferent.

Conclusions

We conclude that dipyrone adds significantly to the analgesic effect of morphine and, when given at the time of starting morphine, results in better pain scores even after dipyrone is discontinued.
Literatur
1.
Zurück zum Zitat Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA et al (2005) Annual report to the nation on the status of cancer, 1975–2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst 97(19):1407–1427, Oct 5 PubMedCrossRef Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA et al (2005) Annual report to the nation on the status of cancer, 1975–2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst 97(19):1407–1427, Oct 5 PubMedCrossRef
2.
Zurück zum Zitat Fallon M, Hanks G, Cherny N (2006) Principles of control of cancer pain. BMJ 332(7548):1022–1024, Apr 29 PubMedCrossRef Fallon M, Hanks G, Cherny N (2006) Principles of control of cancer pain. BMJ 332(7548):1022–1024, Apr 29 PubMedCrossRef
3.
Zurück zum Zitat Volz M, Kellner HM (1980) Kinetics and metabolism of pyrazolones (propyphenazone, aminopyrine and dipyrone). Br J Clin Pharmacol 10(Suppl 2):299S–308S, Oct PubMed Volz M, Kellner HM (1980) Kinetics and metabolism of pyrazolones (propyphenazone, aminopyrine and dipyrone). Br J Clin Pharmacol 10(Suppl 2):299S–308S, Oct PubMed
4.
Zurück zum Zitat Edwards JE, Meseguer F, Faura CC, Moore RA, McQuay HJ (2001) Single-dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev 3:CD003227 PubMed Edwards JE, Meseguer F, Faura CC, Moore RA, McQuay HJ (2001) Single-dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev 3:CD003227 PubMed
5.
Zurück zum Zitat Shinar E, Hershko C (1983) Causes of agranulocytosis in a hospital population: identification of dipyrone as an important causative agent. Isr J Med Sci 19(3):225–229 Mar PubMed Shinar E, Hershko C (1983) Causes of agranulocytosis in a hospital population: identification of dipyrone as an important causative agent. Isr J Med Sci 19(3):225–229 Mar PubMed
6.
Zurück zum Zitat Heit WF (1983) Hematologic effects of antipyretic analgesics. Drug-induced agranulocytosis. Am J Med 75(5A):65–69, Nov 14 PubMedCrossRef Heit WF (1983) Hematologic effects of antipyretic analgesics. Drug-induced agranulocytosis. Am J Med 75(5A):65–69, Nov 14 PubMedCrossRef
7.
Zurück zum Zitat Hamerschlak N, Cavalcanti AB (2005) Neutropenia, agranulocytosis and dipyrone. Sao Paulo Med J 123(5):247–249, Sep 1 PubMedCrossRef Hamerschlak N, Cavalcanti AB (2005) Neutropenia, agranulocytosis and dipyrone. Sao Paulo Med J 123(5):247–249, Sep 1 PubMedCrossRef
8.
Zurück zum Zitat Backstrom M, Hagg S, Mjorndal T, Dahlqvist R (2002) Utilization pattern of metamizole in northern Sweden and risk estimates of agranulocytosis. Pharmacoepidemiol Drug Saf 11(3):239–245, Apr PubMedCrossRef Backstrom M, Hagg S, Mjorndal T, Dahlqvist R (2002) Utilization pattern of metamizole in northern Sweden and risk estimates of agranulocytosis. Pharmacoepidemiol Drug Saf 11(3):239–245, Apr PubMedCrossRef
9.
Zurück zum Zitat Ibanez L, Vidal X, Ballarin E, Laporte JR (2005) Agranulocytosis associated with dipyrone (metamizol). Eur J Clin Pharmacol 60(11):821–829, Jan PubMedCrossRef Ibanez L, Vidal X, Ballarin E, Laporte JR (2005) Agranulocytosis associated with dipyrone (metamizol). Eur J Clin Pharmacol 60(11):821–829, Jan PubMedCrossRef
10.
Zurück zum Zitat Laporte JR, Carne X, Vidal X, Moreno V, Juan J (1991) Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding. Lancet 337(8733):85–89, Jan 12 PubMedCrossRef Laporte JR, Carne X, Vidal X, Moreno V, Juan J (1991) Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding. Lancet 337(8733):85–89, Jan 12 PubMedCrossRef
11.
Zurück zum Zitat Stockler M, Vardy J, Pillai A, Warr D ( 2004) Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial. J Clin Oncol 22(16):3389–3394, Aug 15 PubMedCrossRef Stockler M, Vardy J, Pillai A, Warr D ( 2004) Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial. J Clin Oncol 22(16):3389–3394, Aug 15 PubMedCrossRef
12.
Zurück zum Zitat Kampe S, Warm M, Landwehr S, Dagtekin O, Haussmann S, Paul M et al (2006) Clinical equivalence of IV paracetamol compared to IV dipyrone for postoperative analgesia after surgery for breast cancer. Curr Med Res Opin 22(10):1949–1954, Oct PubMedCrossRef Kampe S, Warm M, Landwehr S, Dagtekin O, Haussmann S, Paul M et al (2006) Clinical equivalence of IV paracetamol compared to IV dipyrone for postoperative analgesia after surgery for breast cancer. Curr Med Res Opin 22(10):1949–1954, Oct PubMedCrossRef
13.
Zurück zum Zitat Rodriguez M, Barutell C, Rull M, Galvez R, Pallares J, Vidal F et al (1994) Efficacy and tolerance of oral dipyrone versus oral morphine for cancer pain. Eur J Cancer 30A(5):584–587 PubMedCrossRef Rodriguez M, Barutell C, Rull M, Galvez R, Pallares J, Vidal F et al (1994) Efficacy and tolerance of oral dipyrone versus oral morphine for cancer pain. Eur J Cancer 30A(5):584–587 PubMedCrossRef
Metadaten
Titel
Adjunct dipyrone in association with oral morphine for cancer-related pain: the sooner the better
verfasst von
José F. Duarte Souza
Paula P. Lajolo
Hélio Pinczowski
Auro del Giglio
Publikationsdatum
01.11.2007
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 11/2007
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-007-0327-7

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