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

Abstract

Our aim was to search whether the addition of Tramadol affected treatment when a dose increase was needed before increasing the transdermal fentanyl (TDF) dose in cancer patients using TDF would have any advantages. Patients were divided into two groups: a Control Group (Group K) and a Tramadol Group (Group T). When patients were first admitted to the polyclinic, demographic data, duration of pain and the first VAS values were recorded. Following the first examination, all patients were given TDF containing 25 µg/h of fentanyl as an initial treatment. During the study period, the TDF dose of patients in Group K was increased in a stepwise fashion of 25 µg/h whenever needed. In Group T, 200 mg of tramadol was added to the treatment without increasing the TDF dose when a dose increase was needed. In subsequent dose increase requirements in Group T, the TDF dose was sequentially increased to 25 µg/h when needed without stopping tramadol. Patients VAS score and adverse effects were recorded in each polyclinic examination. Patients were asked to assess pain treatment with the Treatment Assessment Scale (TAS). Each patient's participation in the study and highest TDF dose reached were recorded. The TDS scores measured at 1 month and 2 months after the start of the study were found to be similar. However, TAS scores measured at the end of the 3rd and 4th months were found to be significantly higher in Group T. The mean TDF dose reached at end of the study was found to be significantly higher in Group K compared to Group T. Itching was observed significantly more frequently among patients of Group K. We found in our study that when TDF and tramadol are used together, TDF need is reduced and the pain management protocol is better tolerated by patients. Based on the results of our study, we suggest concomitant use of strong and weak opioids.