Introduction
Methods
Design and Identification of Experts
Delphi Rounds
Results
Characteristics | Number | Percentage |
---|---|---|
Gender | ||
Men | 58 | 77.3 |
Women | 17 | 22.7 |
Medical speciality | ||
Anaesthesiology | 48 | 64.0 |
Orthopaedics | 9 | 12.0 |
Algology | 9 | 12.0 |
Internal medicine | 4 | 5.3 |
Dentistry | 2 | 2.7 |
Pharmacology | 1 | 1.3 |
Rheumatology | 1 | 1.3 |
Neurology | 1 | 1.3 |
Employment continent | ||
Europe | 57 | 76.0 |
Central and South America | 9 | 12.0 |
Asia | 7 | 9.3 |
North America | 2 | 2.7 |
Experience in pain management, years | ||
> 10 | 67 | 89.3 |
5–10 | 6 | 8.0 |
< 5 | 2 | 2.7 |
Pharmacological features of the orally administered fixed-dose combination (FDC) of dexketoprofen 25 mg and tramadol 75 mg (DKP/TRAM) | |
I | DKP/TRAM FDC combines two well-known drugs with proven efficacy and safety profile |
II | In moderate-to-severe acute pain, the FDC of DKP (a rapidly acting NSAID) plus TRAM (a long-lasting opioid) provides effective analgesia due to its multiple modes and sites of action |
III | In moderate-to-severe acute somatic or visceral pain, the complementary pharmacokinetic profile of DKP with TRAM provides effective analgesia with rapid onset and long duration |
Clinical use of the DKP/TRAM FDC in post-operative pain management | |
IV | DKP/TRAM FDC offers effective multimodal analgesia to treat acute post-operative pain, as recommended by the recent guidelines on the management of post-operative pain |
V | In day case surgery, DKP/TRAM FDC could provide effective and rapid pain management, enabling patients to return more quickly to their normal daily activities |
VI | In major abdominal surgery such as hysterectomy for benign conditions/gynaecological abdominal surgery, DKP/TRAM FDC has represented an effective treatment of moderate-to-severe acute post-operative pain |
VII | In major orthopaedic surgery such as hip or knee replacement, the efficacy of DKP/TRAM FDC in controlling post-operative pain both at rest and on movement could allow early patient mobilization, lowering thromboembolic risk, shortening hospitalization stay and enabling a better rehabilitation |
VIII | The use of the orally administered DKP/TRAM FDC is likely to be envisaged for minor orthopaedic surgeries such as rotator cuff repair, arthroscopic shoulder and knee surgeries, bunionectomy (hallux valgus surgery), meniscectomy, release of the median nerve and fracture management |
IX | DKP/TRAM FDC is likely to be an effective analgesic in minor surgeries such as appendectomies, endoscopic bladder surgery, endoscopic prostatectomy (TURP), plastic surgery of soft parts, rhinoplastic, endoscopic video thoracic surgery, hernia repair, cholecystectomy, ocular surgery, skin surgery, abscess drainage |
X | DKP/TRAM FDC has provided effective and rapid post-operative pain relief in surgical removal of impacted wisdom teeth and dental surgeries |
Clinical use of the DKP/TRAM FDC in non-surgical pain | |
XI | DKP/TRAM FDC is likely to provide a good mean for effective pain management in moderate-to-severe acute dental pain due to its shorter time to onset of analgesia and its anti-inflammatory activity |
XII | Owing to its pharmacological profile, DKP/TRAM FDC could be an important tool in controlling moderate-to-severe pain in acute exacerbations of osteoarticular pain where nociceptive and neuropathic mechanisms are involved in both the local and central levels |
XIII | Owing to its pharmacological profile, DKP/TRAM FDC will probably have an important role in pain control in acute exacerbations of low back pain since both components (DKP & TRAM) have proven efficacy, and where nociceptive and neuropathic mechanisms are involved at both local and central levels |
XIV | DKP/TRAM FDC, targeting different sites of action, is suitable for mixed types of pain, arising from different body structures (joints, muscles, ligaments, etc.) such as acute articular pain or non-specific low back pain |
XV | DKP/TRAM FDC, owing to its multiple modes and sites of action, could be an important addition in the control of post-traumatic pain with somatic and neuropathic component (e.g. soft tissue trauma, dislocated long bone fractures, extremities fractures) |
Advantages of the DKP/TRAM FDC | |
XVI | DKP/TRAM FDC offers additional advantages over non-fixed combinations, including ease of administration, reduction of pill burden and will improve adherence by patients |
XVII | The oral route of administration of DKP/TRAM FDC improves patient compliance and adherence to treatment and will be of advantage in the outpatient setting |
XVIII | DKP/TRAM FDC could be of great value when other single or combined drugs were less efficacious or could not be tolerated because of adverse side effects |
XIX | In moderate-to-severe acute pain, the DKP/TRAM FDC generates effective and rapid analgesia reducing burden of pain. This in turn may potentially have a positive impact on psychosocial aspects of acute pain such as psychological vulnerability, stress, higher healthcare utilization and reduced labour force participation |
Pharmacological features of the orally administered fixed-dose combination (FDC) of dexketoprofen 25 mg and tramadol 75 mg (DKP/TRAM) | |
a | DKP/TRAM FDC provides a good means for effective analgesia at reduced doses of individual agents with a potential reduction of opioid dose-related adverse events such as constipation, respiratory depression, nausea and vomiting |
b | Safety profile of DKP/TRAM FDC is fully in line with that previously known for the single agents in monotherapy |
Clinical use of the DKP/TRAM FDC in post-operative pain management | |
c | DKP/TRAM FDC has a potential advantage in moderate-to-severe acute post-operative pain owing to its rapid onset of action. This in turn may reduce risks of medical complications and of developing chronic pain, allowing a fast hospital discharge and a more effective outpatient pain management |
d | DKP/TRAM FDC will provide effective analgesia in major surgeries, when the oral route (or the switch to it) is feasible |
Clinical use of the DKP/TRAM FDC in non-surgical pain | |
e | The orally administered DKP/TRAM FDC provides effective analgesia in moderate-to-severe acute symptomatic painful conditions and its use is likely to be shown as beneficial in a wide range of non-surgical clinical conditions |
f | In acute cervical pain, DKP/TRAM FDC through very effective analgesia may allow one to reduce the muscular tension and the consequent spasmodic pain |
g | DKP/TRAM FDC has the potential to be useful for renal colic pain and dysmenorrhoea, a distressing condition with important visceral component and particularly for secondary dysmenorrhoea caused by endometriosis, since the two components (DKP & TRAM) have proven efficacy in those pain syndromes |
Advantages of the DKP/TRAM FDC | |
h | In specific pain models, less rescue medications were needed when the DKP/TRAM FDC was used |
i | Compared to the single agents in monotherapy, DKP/TRAM FDC offers potential benefits such as longer time to re-medication and better patient global evaluation |