Orale Opiattherapie bei Patienten mit “nicht-malignen” Schmerzen

Abstract

Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. When all other thrapeutic measures fail to control pain, patients with non-malignant pain can also be treated by opioids. We report 70 patients with severe pain who were given opioids as the ultima ratio in pain therapy: 50 received buprenorphine sublingual tablets, 13 received morphine sustained release tablets and the remaining 7 were treated with other opioids. The mean daily dose was 1.45 mg buprenorphine or 87.6 mg morphine. The dosage increased in 12 of the 50 patients treated with buprenorphine while 5 of the 13 morphine patients needed increasing dosage. The other patients had a constant dosage after the initial period of dose-finding. In more than 50% the pain could be effectively controlled by oral opioids. The general performance status (Karnofsky) increased from 63.6% to 74.1%. The typical side effects were constipation and nausea. Prophylaxis of constipation is most important during opioid therapy. No case of respiratory depression or opioid addiction was registered. Our results show that patients with musculo-skeletal and deafferentation pain respond better to opioids than patients with headache. Negative results were observed in some patients with neuropathic pain. The results of the study show that opioids are justifiable for the treatment of non-malignant pain and can be given without danger over a long period of time. Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain —therefore, they should be given “by the clock”. Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.

Zusammenfassung

Wenn alle anderen Therapiemaßnahmen unwirksam bleiben, können Patienten mit sog. “nicht malignen”, inkurablen chronischen Schmerzen wirkungsvoll mit Opioiden behandelt werden. Dies zeigt die vorliegende Studie an 70 Patienten, die im Zeitraum 1987 bis 1989 eine solche Therapie als Ultima ratio erhielten. In über 50% der Fälle war bei den 70 Patienten eine gute Schmerzreduktion möglich. Teilweise fanden jahrzehntelange Schmerzanamnesen ihren Abschluß. Nebenwirkungen waren denen einer Opiattherapie bei Tumorpatienten vergleichbar. Obstipation stand im Vordergrund. Wir sahen niemals eine Atemdepression. Die Leistungsfähigkeit der Patienten stieg unter der Therapie an. Die häufig fälschlicherweise befürchtete Abhängigkeit von Opioiden trat bei den untersuchten Patienten nicht auf.