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Biomedical subjects

N H Jensen

Publications and source records attributed to N H Jensen.

At least 19 recordsLinked to original sources
PubMed2002

Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine.

BACKGROUND: Morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G) are the two most important metabolites of morphine. Both are pharmacologically active, however, with different effects. M-6-G has been demonstrated capable of inducing anti-nociception and sedation, and M-3-G may induce behavioural excitation and possibly antagonise anti-nociception. Their impact on pharmacodynamics in patients in long-term treatment with oral morphine remains to be settled. METHODS: Forty-two cancer patients treated with oral sustained-release (SR) morphine were assessed for pain, sedation and other side effects related to morphine treatment. Blood samples were analysed for morphine, M-3-G and M-6-G by high-performance liquid chromatography (HPLC). RESULTS: Significant correlations were found between the daily dose of SR morphine and plasma morphine (M) (r = 0.535, P < 0.001), plasma M-6-G (r = 0.868, P < 0.001) and plasma M-3-G (r = 0.865, P < 0.001). There was no relationship between plasma morphine, M-6-G, M-6-G/M and pain and sedation scores. Seventy-nine percent of the patients suffered from dryness of the mouth, which was the most frequent side effect observed. Patients in this group had higher plasma morphine and M-6-G concentrations than patients who did not suffer from this side effect. CONCLUSION: The plasma concentrations of morphine and its metabolites, M-3-G and M-6-G, are significantly correlated to the daily dose of SR morphine. Although M-6-G has analgesic properties, no associations were found between pain and plasma morphine and morphine metabolites. This may be due to the multitudinous factors affecting the dose-effect relationship. Patients with dryness of the mouth had higher concentrations of morphine and M-6-G than patients without this side effect.

Adult↗
PubMed2001

Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain.

OBJECTIVES: To compare patients' preference for transdermal fentanyl or sustained release oral morphine, their level of pain control, and their quality of life after treatment. DESIGN: Randomised, multicentre, international, open label, crossover trial. SETTING: 35 centres in Belgium, Canada, Denmark, Finland, the United Kingdom, the Netherlands, and South Africa. PARTICIPANTS: 256 patients (aged 26-82 years) with chronic non-cancer pain who had been treated with opioids. MAIN OUTCOME MEASURES: Patients' preference for transdermal fentanyl or sustained release oral morphine, pain control, quality of life, and safety assessments. RESULTS: Of 212 patients, 138 (65%) preferred transdermal fentanyl, whereas 59 (28%) preferred sustained release oral morphine and 15 (7%) expressed no preference. Better pain relief was the main reason for preference for fentanyl given by 35% of patients. More patients considered pain control as being "good" or "very good" with fentanyl than with morphine (35% v 23%, P=0.002). These results were reflected in both patients' and investigators' opinions on the global efficacy of transdermal fentanyl. Patients receiving fentanyl had on average higher quality of life scores than those receiving morphine. The incidence of adverse events was similar in both treatment groups; however, more patients experienced constipation with morphine than with fentanyl (48% v 29%, P<0.001). Overall, 41% of patients experienced mild or moderate cutaneous problems associated with wearing the transdermal fentanyl patch, and more patients withdrew because of adverse events during treatment with fentanyl than with morphine (10% v 5%). However, within the subgroup of patients naive to both fentanyl and morphine, similar numbers of patients withdrew owing to adverse effects (11% v 10%, respectively). CONCLUSION: Transdermal fentanyl was preferred to sustained release oral morphine by patients with chronic non-cancer pain previously treated with opioids. The main reason for preference was better pain relief, achieved with less constipation and an enhanced quality of life.

Administration, Cutaneous↗
PubMed1999

Steady-state kinetics and dynamics of morphine in cancer patients: is sedation related to the absorption rate of morphine?

Eighteen patients suffering from chronic pain due to cancer completed a balanced, double-blind, double-dummy, two period cross-over trial comparing the pharmacokinetics (PK) and pharmacodynamics (PD) of morphine and its metabolites, morphine-3-glucuronide and morphine-6-glucuronide, after administration of morphine given as controlled-release (CR) tablets (every 12 h) and immediate-release (IR) tablets (every 6 h). The same total daily dose of morphine was given in both study periods. Patients received both test formulations for 4 days and on the final day of each period, peripheral venous blood samples for analysis of morphine, morphine-3-glucuronide, and morphine-6-glucuronide were obtained. Pain intensity, sedation, and continuous reaction time (CRT) were assessed. No significant differences could be demonstrated in AUC/dose, Cmin, Cmax or fluctuation index values between the two treatments (IR and CR tablets) for either morphine or its metabolites. Tmax for morphine and its metabolites occurred significantly later after administration of CR tablets than after administration of IR tablets. There were no significant differences between the IR and the CR formulation with respect to analgesia and side effects, and there was no difference in the patients' overall impression of the two treatments. More important, there was no difference between the Tmax and the time to peak sedation after administration of IR tablets (P = 0.63). However, due to the relatively small number of patients and the variability in the data, the statistical power of the test was only 0.074. The risk of a type II error is 0.926. These data demonstrate the PK and PD similarities and differences between CR and IR morphine. They suggest that there may be a relationship between Tmax (determined by absorption rate) and sedation, but further evaluation of this potential relationship is needed.

Aged↗
PubMed1997

[Treatment of cancer pain in Denmark. A questionnaire survey].

A questionnaire survey was carried out with the aim of evaluating knowledge about and practice of cancer pain treatment in Denmark. A questionnaire was sent to a 10% random sample of Danish physicians. Of these 1411 physicians, 1068 (76%) returned the questionnaires and after the exclusion of those doctors who never treated cancer patients, 577 (54%) were analyzed. Their knowledge of the principles and practice of cancer pain treatment was evaluated by means of 14 multiple-choice and open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of three simulated patient cases. Ninety-seven percent of the physicians recognized difficulties in cancer pain treatment, the most frequent being side effects of drugs and inadequate pain relief. It appeared from the proposals for pain treatment of the patient cases that the majority of the physicians could treat both pain from bone metastasis (75%) and visceral pain (78%) satisfactorily, while very few suggested coanalgesics for neuropathic pain (20%). Older physicians performed less satisfactorily than did their younger colleagues. Basic pain treatment skills have been acquired by the Danish physicians. However, in the future emphasis should be placed on the treatment of neuropathic pain with coanalgesics and the management of opioid side-effects.

Analgesia↗
PubMed1995

[Morphine-induced hyperalgesia, allodynia and myoclonus--new side-effects of morphine?].

During the last ten years hyperalgesia (H), allodynia (A) and myoclonia (M) has been reported at an increased frequency in human beings treated with morphine. The side effects are most common in cancer patients treated with high dose morphine, and has been reported for all routes of administration. The mechanisms are unknown, but human cases and experimental works have resulted in the following theories: 1) Morphine and morphine metabolites change the postsynaptic pain-transmission in dorsal horn neurones via non opioid-receptors (glycine and/or N-methyl-D-aspartate). 2) Morphine and morphine metabolites activate other opioid receptor populations. 3) Supplemental drugs in cancer management. 4) An abnormal metabolism of morphine or morphine metabolites. 5) A combination of one or more of the above-mentioned theories. The first mentioned theory is the most likely. The treatment of morphine induced H, A, and M seems to be to discontinue morphine administration and to initiate therapy with other opioids (fentanyl, sufentanyl, methadone or ketobemidone).

Humans↗
PubMed1993

[Cerebral dysfunction after prolonged use of opioids].

Cerebral dysfunction due to long-term treatment with opioids is a problem of increasing relevance because of the rapidly growing use of opioids. A review of psychomotor and cognitive test methods is given, including their application in patients on long-term opioid treatment. The findings of the most valid studies on cancer patients in long-term treatment with opioids are an increase in continuous reaction time and subjective sedation score regardless of the routes of administration. Studies of drug addicts in long-term treatment with opioids seem to reflect a lowering of the general level of activity. According to recent studies, patients with chronic non-malignant pain conditions are responsible for the major part of the total opioid consumption. So far, no studies of cerebral dysfunction have been performed on this group of patients. Further research should concentrate on the use of few valid psychomotor and cognitive tests and should include patients with chronic non-malignant pain conditions.

Analgesics, Opioid↗
PubMed1991

[Factitious disorder--an iatrogenic disease?].

The case of a woman aged 31 years with numerous contacts with the health care system is reported. The patient presented an extremely varied pattern of complaints with pain as one of the most frequently recurring reasons for admission. During the past 12 to 13 years, the patient was admitted to inpatient units on numerous occasions and was submitted to numerous examinations, most of which revealed normal findings. This article lists a number of possible background causes which might permit a career like this to develop. Measures for prevention of similar "case-stories" in future are discussed.

Adult↗
PubMed1991

Accurate diagnosis and drug selection in chronic pain patients.

Chronic somatic pain patients often present more than one pain location with concomitant different pain complaints (pain qualities) which may need to be treated individually. Major attention should be given to the identification of opioid insensitive neurogenic pain qualities, and to a lesser degree the pain intensity. The following pain qualities are of interest: Diffuse deep located nagging pain which is treated with peripherally acting analgesics and/or long acting opioids. Dysaesthetic pain, described as a superficial burning sensation, is usually only partially responsive to opioids and may be treated with antidepressants, whereas neuralgic pain usually is unresponsive to opioids and may be treated with anticonvulsants. Other special pain qualities should be treated as specifically as possible. With this differentiated pharmacological therapy approximately 70-90% of somatic pain patients can be treated with satisfactory pain relief or freedom from pain, at least at rest.

Analgesics↗
PubMed1990

[Transcutaneous nerve stimulation as palliative treatment of pain].

The value of transcutaneous nerve stimulation (TNS) for palliative relief of pain is reviewed. The presumed mechanisms of effect are briefly described and a review of recent literature concerning TNS for acute and chronic pain, respectively, is presented. In addition, advice is given for the choice of apparatus and the technique employed is described. It is concluded that TNS may be tried with advantage in the treatment of a number of acute and chronic painful conditions of neurogenic/nocioceptive nature and that TNS has the advantage over e.g. acupuncture that the patient can administer the treatment himself.

Evaluation Studies as Topic↗
PubMed1990

Maternal opinion about analgesia in labour and delivery. A comparison of epidural blockade and intramuscular pethidine.

In a prospective randomized study we evaluated the opinion of 97 parturients on either epidural analgesia or parenteral pethidine with respect to analgesic efficacy, general feelings and symptoms during labour and delivery. The analgesic effect of the epidural block was significantly superior to pethidine with regard to the pain score (visual analogue scale (VAS)0 during the first stage of labour (mean VAS 11 contrasting 65). Moreover, 30 (59%) women in the epidural group compared to 9 (20%) in the pethidine group had a painless labour and delivery. Significantly more parturients (37 (73%)) in the epidural group would request an epidural blockade rather than pethidine treatment (14 (30%)) in a subsequent labour. Fewer side effects were registered in the epidural group compared to the pethidine group, however only significantly concerning sleepiness. It is concluded that in this study low-dose epidural analgesia during the first stage of labour was superior to parenteral pethidine regarding pain relief and side effects.

Analgesia, Epidural↗
PubMed1989

[Long-term treatment with intrathecal morphine in severe painful cancer].

Intrathecal treatment with morphine was instituted in seven cancer patients with severe pain. All of the patients had already received treatment with epidural morphine and the reason for the change in treatment was insufficient effect, side effects and/or pain connected with the injections in the epidural form of therapy. The duration of treatment was 5-136 days (median 40 days). The daily intrathecal dosage of morphine which was administered by 1-4 daily injections was initially 2.4-16.0 mg (median 3.6 mg) and had to be increased to 3.2-112 mg (median 16 mg) at the conclusion of treatment. Five patients became free from pain and one had acceptable relief of pain on this treatment. One patient received accidentally too great a dose of morphine intrathecally as compared with the usual dose and required treatment for respiratory insufficiency. Apart from postural headache on account of leakage of cerebro-spinal fluid, which could be treated by epidural blood "patch", the method was without complications which could be attributed to the intrathecally placed catheter. Treatment of pain with opioids injected intrathecally may thus be recommended in the cases in which epidural treatment cannot be carried out on account of the reasons mentioned above.

Adult↗
PubMed1989

[A pharmacologic respiratory stimulant, doxapram, used in acute deterioration in patients with chronic respiratory failure].

In a controlled study with random allocation, the effect of doxapram (Dopram), a respiratory stimulant, was evaluated in 25 patients with acute on chronic respiratory failure requiring ventilator support. Eleven patients were allocated to mechanical ventilation and 14 to treatment with doxapram given as a variable rate infusion. In the doxapram group only four were transferred to mechanical ventilation after 1 1/2 to three days of treatment. In these patients, the problem giving rise to the acute exacerbation, was not under control at the time of ventilator intervention. In the remainder of the group, antibiotics, diuretics and bronchodilators had successfully treated the exacerbation. All patients were discharged alive. In the doxapram-treated group duration of hospitalization was nine days compared to 14 days (median values) in the ventilator-treated group. Only minor side-effects from doxapram were observed, and it is concluded that this respiratory stimulant can be used as a primary drug in patients with acute respiratory failure and chronic airflow limitation.

Aged↗