Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients
Background: Tramadol is known to provide synergistic analgesia when used in combination with morphine. Objectives: The aims of this study were: (1) to introduce an opioid combination therapy using pure-μ-opioid receptor agonist (OPI) + tramadol injections (OPI + tramadol) and (2) to elucidate safety...
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| Language: | English |
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Mary Ann Liebert
2024-10-01
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| Series: | Palliative Medicine Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/pmr.2023.0061 |
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| author | Tetsumi Sato Shigeki Ono Tetsu Sato Rei Tanaka Yoshiko Kamo Tomomi Suzuki |
| author_facet | Tetsumi Sato Shigeki Ono Tetsu Sato Rei Tanaka Yoshiko Kamo Tomomi Suzuki |
| author_sort | Tetsumi Sato |
| collection | DOAJ |
| description | Background: Tramadol is known to provide synergistic analgesia when used in combination with morphine. Objectives: The aims of this study were: (1) to introduce an opioid combination therapy using pure-μ-opioid receptor agonist (OPI) + tramadol injections (OPI + tramadol) and (2) to elucidate safety and efficacy of this combination therapy for opioid-naïve cancer pain patients. Methods: Opioid-naïve patients referred to our palliative care team (in Japan) who were unable to take oral medications and received OPI + tramadol as opioid induction agents were retrospectively investigated on the electric medical chart. OPI + tramadol dosage was adjusted to achieve the patient’s pain as Numerical Rating Scale ≤4/10 or Support Team Assessment Schedule-Japanese ≤1. Patients’ demography, doses of OPI and tramadol administered, and adverse events were analyzed. Results: A total of 44 patients were included. The primary organs of malignancy were pancreas (11), stomach (5), lung (4), breast (4), liver (4), and others (13). OPI injections administered were hydromorphone (39), morphine (6), oxycodone (1), and fentanyl (1). The starting doses of OPI (morphine equivalent) and tramadol were 6.05 ± 1.63 and 67.8 ± 13.6 mg/day, respectively, and the final doses of OPI (morphine equivalent) and tramadol were 8.14 ± 3.85 and 80.0 ± 28.5 mg/day, respectively. Treatment goals were achieved in all patients. There were three patients in whom OPI was switched owing to inadequate analgesia and no new side effects other than those known to occur when OPI or tramadol is administered appeared. Conclusion: The results suggest that this innovative and unique opioid therapy can be safely and effectively introduced to opioid-naïve cancer patients who are relatively close to the end of life. |
| format | Article |
| id | doaj-art-e37b85389cf34a8fbc71870b69a5ceee |
| institution | Kabale University |
| issn | 2689-2820 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Palliative Medicine Reports |
| spelling | doaj-art-e37b85389cf34a8fbc71870b69a5ceee2025-08-20T03:49:37ZengMary Ann LiebertPalliative Medicine Reports2689-28202024-10-015134034910.1089/pmr.2023.0061Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer PatientsTetsumi Sato0Shigeki Ono1Tetsu Sato2Rei Tanaka3Yoshiko Kamo4Tomomi Suzuki5Division of Palliative Medicine, Shizuoka Cancer Center, Shizuoka, Japan.Division of Palliative Medicine, Shizuoka Cancer Center, Shizuoka, Japan.Palliative Care Team, Shizuoka Cancer Center, Shizuoka, Japan.Palliative Care Team, Shizuoka Cancer Center, Shizuoka, Japan.Palliative Care Team, Shizuoka Cancer Center, Shizuoka, Japan.Palliative Care Team, Shizuoka Cancer Center, Shizuoka, Japan.Background: Tramadol is known to provide synergistic analgesia when used in combination with morphine. Objectives: The aims of this study were: (1) to introduce an opioid combination therapy using pure-μ-opioid receptor agonist (OPI) + tramadol injections (OPI + tramadol) and (2) to elucidate safety and efficacy of this combination therapy for opioid-naïve cancer pain patients. Methods: Opioid-naïve patients referred to our palliative care team (in Japan) who were unable to take oral medications and received OPI + tramadol as opioid induction agents were retrospectively investigated on the electric medical chart. OPI + tramadol dosage was adjusted to achieve the patient’s pain as Numerical Rating Scale ≤4/10 or Support Team Assessment Schedule-Japanese ≤1. Patients’ demography, doses of OPI and tramadol administered, and adverse events were analyzed. Results: A total of 44 patients were included. The primary organs of malignancy were pancreas (11), stomach (5), lung (4), breast (4), liver (4), and others (13). OPI injections administered were hydromorphone (39), morphine (6), oxycodone (1), and fentanyl (1). The starting doses of OPI (morphine equivalent) and tramadol were 6.05 ± 1.63 and 67.8 ± 13.6 mg/day, respectively, and the final doses of OPI (morphine equivalent) and tramadol were 8.14 ± 3.85 and 80.0 ± 28.5 mg/day, respectively. Treatment goals were achieved in all patients. There were three patients in whom OPI was switched owing to inadequate analgesia and no new side effects other than those known to occur when OPI or tramadol is administered appeared. Conclusion: The results suggest that this innovative and unique opioid therapy can be safely and effectively introduced to opioid-naïve cancer patients who are relatively close to the end of life.https://www.liebertpub.com/doi/10.1089/pmr.2023.0061cancer painμ-opioid receptor agonistopioid combination therapyopioid naïvetramadol |
| spellingShingle | Tetsumi Sato Shigeki Ono Tetsu Sato Rei Tanaka Yoshiko Kamo Tomomi Suzuki Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients Palliative Medicine Reports cancer pain μ-opioid receptor agonist opioid combination therapy opioid naïve tramadol |
| title | Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients |
| title_full | Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients |
| title_fullStr | Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients |
| title_full_unstemmed | Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients |
| title_short | Safety and Efficacy of Combined Injection of Pure-μ-Opioid Agonist with Tramadol as an Opioid Induction Agent for Opioid-Naïve Cancer Patients |
| title_sort | safety and efficacy of combined injection of pure μ opioid agonist with tramadol as an opioid induction agent for opioid naive cancer patients |
| topic | cancer pain μ-opioid receptor agonist opioid combination therapy opioid naïve tramadol |
| url | https://www.liebertpub.com/doi/10.1089/pmr.2023.0061 |
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