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Biomedical subjects

P Sjøgren

Publications and source records attributed to P Sjøgren.

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

[Sociodemographic predictors of therapeutic results in patients with chronic, non-malignant pain].

INTRODUCTION: Chronic pain is in its nature multidimensional and is most successfully treated by a multidisciplinary approach. Some patients do not benefit from treatment, and psychological and socio-economic factors may play a major role. The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary treatment in patients with chronic pain who where referred consecutively to a Danish multidisciplinary pain centre. METHOD: Pain scores (VAS) and health-related quality of life (HRQL) were assessed. On entry and three and six months later HRQL was evaluated by medical outcome short form (SF-36) and the psychological general well-being scale (PGWB). Sociodemographic variables were: age, gender, educational level, civil status employment status, and disability pension (DP) status. RESULTS: Of the sociodemographic variables evaluated, only the DP status seemed to be a significant outcome predictor. Patients applying for a DP do not improve. Patients receiving a DP and those who do not achieved moderate improvements, but these were significantly larger. The same pattern was seen for changes in psychological well-being and social functioning. The DP status predicted improvement in pain and social functioning. DISCUSSION: The present study indicates that the multidimensional problems experienced by patients applying for a DP are dominated by sociodemographic factors. Focus on the solution of these socio-economic problems is important, if patients with chronic pain are to benefit from multidisciplinary pain treatment.

Adult↗
PubMed2001

[Therapeutic results in chronic, non-malignant pain in patients treated at a Danish multidisciplinary pain center compared with general practice. A randomized controlled clinical trial].

INTRODUCTION: Multidisciplinary pain treatment (MPT) is generally considered to be the most effective treatment of chronic pain, but its long-term effect has not yet been firmly established. METHODS: This randomised controlled study compared the effect of outpatient MPT with that of treatment by general practitioners after initial supervision by a pain specialist (GP group) and with a six-month waiting list group (WL group). The participants were 189 patients with chronic non-malignant pain. On referral and at three and six months, the patients filled in questionnaires evaluating pain intensity, health-related quality of life (HRQL), and the use of analgesics. RESULTS: At six months, the patients allocated to MPT (N = 63) reported a reduction in pain intensity (p < 0.001), and an improvement in psychological well-being (p < 0.001), quality of sleep (p < 0.05), and physical functioning (p < 0.05). The WL group (N = 63) had a statistically significant deterioration in most of the HRQL measures. The only effect of treatment found in the GP group was a reduction in the use of short-acting opioids. In the MPT group, the use of opioids administered on demand and short-acting opioids was decreased (p < 0.001). No change in the use of analgesics was seen in the WL group. DISCUSSION: The study showed that (i) in the MPT group there was a significant reduction in pain intensity and an improvement in HRQL compared to the WL group, and (ii) the mere establishment of a pain diagnosis and management plan by a specialist was not sufficient to enable the referring GP to manage patients with severe chronic pain.

Adult↗
PubMed2001

Does the medical record cover the symptoms experienced by cancer patients receiving palliative care? A comparison of the record and patient self-rating.

The aim of this study was to investigate the extent to which the symptoms experienced by advanced cancer patients were covered by the medical records. Fifty-eight patients participated in the study. On the day of first encounter with our palliative care department, a medical history was taken, and on this or the following day, the patients completed the EORTC Quality of Life Questionnaire (EORTC QLQ-C30), Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS). The symptomatology reported in the patient-completed questionnaires was compared with the symptomatology mentioned by the physician in the medical record. The analysis revealed good concordance concerning pain, but most other symptoms or problems were reported much more often by patients than by their doctors. Reasons for these discrepancies are discussed. It is suggested that the doctor's knowledge of the patient's symptomatology might gain from more systematic screening and transfer of information from patient self-assessment questionnaires to the medical records.

Adult↗
PubMed2001

Economic evaluation of multidisciplinary pain management in chronic pain patients: a qualitative systematic review.

In this qualitative systematic review, we have evaluated studies of the economic effectiveness of multidisciplinary pain treatment in chronic non-malignant pain patients. Published reports were identified from a systematic search of bibliographic databases (MEDLINE and EMBASE) and reference lists of retrieved reports. Fourteen reports of nine studies of patients suffering from back pain, fibromyalgia, and mixed chronic pain conditions were considered to be appropriate as economic analyses. In the selected studies, we found serious methodological problems in study designs and application of outcome measures. The quality of the cost measurements was characterized by an apparent lack of tradition using economic methodology. This review does not give an answer to whether multidisciplinary pain management in chronic pain patients is cost-effective or not. Application of standard methods of costing and outcome measurement are essential before studies of cost-effectiveness in multidisciplinary pain treatment can be used in decision-making and planning.

Chronic Disease↗
PubMed2000

Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status.

The aim of the present study was to evaluate the possible influence of oral opioids, pain and performance status on some aspects of psychomotor function and cognition in cancer patients. One hundred and thirty cancer patients between 40 and 76 years of age were consecutively included in the study. In order to separate the impact of performance status, pain and oral opioids on neuropsychological functioning the patients were allocated in a cross-sectional design to five different groups. Group 1 (N=40), which was considered the control group, was characterized by being in Karnofsky Performance Status (KPS) A ('Able to carry on normal activity and work. No special care is needed'), had no pain and received no oral opioid medication. Group 2 (N=19) was characterized by being in KPS B ('Unable to work. Able to live at home and care for most personal needs. A varying degree of assistance is needed'), had no pain and received no oral opioid medication. Group 3 (N=19) was characterized by being in KPS B, had pain, but received no oral opioid medication. Group 4a (N=31) was characterized by being in KPS B, had pain and received stable doses of oral opioids. Group 4b (N=21) was characterized by being in KPS B, had no pain and received stable doses of opioids. Assessments comprised pain intensity, sedation, opioid doses, time from ingestion of last opioid dose to testing and opioid side effects. The neuropsychological tests used were continuous reaction time (CRT), finger tapping test (FTT) and paced auditory serial addition task (PASAT). Regarding the neuropsychological tests group 1 was compared with each of the other groups and respecting the hierarchy of increasing numbers of stigmatizing factors group 1 was compared with group 2, group 2 with group 3 and so forth. Concerning CRT, group 1 performed statistically significantly faster than groups 2, 4a and 4b. Concerning FTT, group 1 performed statistically significantly faster than groups 3 and 4a. Concerning PASAT, groups 1 and 4b performed statistically significantly better than group 4a. Furthermore, the pain-relieved groups 2 and 4b performed statistically significantly better in PASAT than the pain-suffering groups 3 and 4a. We conclude that in cancer patients the impact of stigmatizing factors (oral opioids, pain and reduced performance status) seems to impair some important aspects of neuropsychological performance, but more specifically our results indicate that (1) the use of long-term oral opioid treatment in cancer patients per se did not affect any of the neuropsychological tests used in the present study, (2) cancer patients being in KPS B had statistically significantly slower CRT than patients being in KPS A and (3) pain itself may deteriorate the performance of PASAT more than oral opioid treatment.

Administration, Oral↗
PubMed2000

Treatment outcome of chronic non-malignant pain patients managed in a danish multidisciplinary pain centre compared to general practice: a randomised controlled trial.

This randomised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine chronic non-malignant pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P </= 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients.

Adult↗
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↗
PubMed1999

Oral glycopyrrolate alleviates drooling in a patient with tongue cancer.

Although sialorrhea and drooling are uncommon symptoms in cancer patients, they can cause considerable discomfort, inconvenience and social embarrassment. In this article we describe a patient with tongue cancer who was successfully treated with oral glycopyrrolate 0.4 mg 3 times daily. Glycopyrrolate is a quaternary ammonium compound. In contrast to the recommended treatment with scopolamine, glycopyrrolate is virtually without side effects to the central nervous system because it penetrates the blood-brain barrier poorly. Glycopyrrolate has a slow and erratic absorption from the gastrointestinal system, but even low plasma levels are associated with a distinct and long-lasting antisialogic effect.

Female↗
PubMed1998

[Pain epidemiology and health-related quality of life in patients with chronic non-malignant pain].

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients referred to a Danish multidisciplinary pain centre. Mean pain intensity was 71.6 (SD 18.5) on the VAS scale. HRQL was evaluated using the questionnaires: SF-36, HAD and PGWB. Compared with the normal population (NP) both physical, psychological and social well-being was severely reduced, and 58% were found to have a depressive or anxiety disorder. Sixty-three percent of the patients had neurogenic pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants. At referral 73% were treated with opioids. Mean opioid consumption was 64 mg of morphine per day. Patients had used the health care system five times more often than the NP (p < 0.001). The study showed that HRQL of chronic non-malignant pain patients is among the lowest observed for any medical condition.

Adult↗
PubMed1998

[Epidemiology of cancer pain].

The prevalence of pain in cancer patients is influenced by several factors, for example the cancer disease, stage of disease, metastases present and treatment. However, only very few studies take all these factors in account when presenting the prevalence of pain in cancer patients. Pain may be caused by direct tumour infiltration, but may also be indirectly related to the cancer disease, caused by the cancer treatment or unrelated to the cancer. The most frequent pain quality is somatic pain followed by visceral and neuropathic pain. Pain with certain qualities or characteristics, such as incident pain, tenesmi in the gastrointestinal tract or cramps located to the bladder or rectum are more difficult to relieve than other pains. Other factors, such as major psychological distress, fast increasing doses of opioids and a past history of addictive behaviour may also be predictive of a poor treatment outcome. Besides pain cancer patients may also suffer from other troublesome symptoms such as asthenia, anorexia, constipation, nausea and vomiting and poor quality of sleep. These symptoms have great impact on the patients' well-being and should be treated contemporarily.

Humans↗
PubMed1998

Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories.

BACKGROUND: Recently, clinical reports have suggested a relationship between the occurrence of hyperalgesia, allodynia and/or myoclonus and treatment with high doses of morphine in humans. Although few clinical descriptions of these phenomena are available, experimental work supports the notion that high doses of morphine may play a pathogenetic role in the observed behavioural syndrome. METHODS: Six patients, four with malignant and two with chronic, non-malignant pain conditions, treated with moderate to high doses of oral, continuous intravenous infusion or intrathecal morphine developed hyperalgesia, allodynia and/or myoclonus. When the side-effects occurred, blood or CSF samples were taken and analyzed for contents of morphine, morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G). RESULTS: When comparing the plasma and CSF concentrations from these patients with data from available literature obtained from patients not suffering from these side-effects, it was demonstrated that the values deviated in five patients. In all six patients, the side-effects disappeared after substituting morphine with other opioid agonists or after lowering the daily dose of morphine. CONCLUSION: These results may indicate that elevated concentrations of M-3-G in plasma as well as the plasma and CSF M-3-G/M-6-G ratios may play a pathogenetic role in the development of hyperalgesia, allodynia and myoclonus.

Aged↗
PubMed1998

[Denmark's first research facility in palliative medicine. Organization and research strategy].

Denmark's first palliative medicine research unit is now being set up at Bispebjerg Hospital, with single-room and two double-room ward. The multidisciplinary team consists of doctors, a psychologist, nurses, a physiotherapist, an ergotherapist, a medical social worker, a priest and a dietician. An out-patient facility is also being established to enable patients to choose between hospitalisation out-patient treatment or home treatment by appropriate staff. Another aspect of palliative medicine is care of the patient's family members. The intervention offered at our facility is led by a psychologist, and consists primarily of counselling. With its limited clinical opacity, the department of palliative medicine is first and foremost a research and development facility. The first chair in palliative medicine in Denmark was conferred upon the department in 1998.

Denmark↗
PubMed1997

[Morphine metabolism--pharmacokinetics and pharmacodynamics].

With the increasing use of morphine, growing interest for the clinical implications of its metabolites, morphine-3-glucuronide (M-3-G) and morphine-6-glucuronide (M-6-G) has emerged in the literature. M-6-G binds to the opioid receptor and has analgesic properties in man. Clinical studies have not delivered strong evidence of significant correlation between the concentration of morphine and its glucuronides in plasma and cerebrospinal fluid and pharmacodynamics such as analgesia. There is no clinical evidence to indicate that M-6-G has a pronounced respiratory depressing effect in man, while the literature contains conflicting reports with regard to other side-effects. M-3-G does not bind to the m-opioid receptor and consequently has no antinociceptive effects. Studies in rodents have shown that morphine, M-6-G and especially M-3-G may induce hyperalgesia, allodynia and myoclonus. It is assumed that these side effects are caused by a spinal antiglycinergic mechanism. The role of M-3-G in morphine antagonism and development of tolerance has not yet been settled. As M-3-G and M-6-G are eliminated by the kidneys, renal insufficiency will lead to accumulation of these. Accordingly dosage should be reduced or other opioids be considered in such cases.

Humans↗
PubMed1997

[Malignant bone pain].

Bone pain is one of the most frequent causes of pain in patients with cancer, and the levels of metastases and bone pain are not directly correlated. Nociceptors in the periosteum are probably stimulated by halisteresis or by inflammatory oedema leading to an increase in the intraosseous pressure. Some authors believe that the nociceptors in bone are mediated via intraosseous mechanoreceptors in the bone-matrix. At a low pain level the initial treatment is acetylsalicylic acid, paracetamol or other nonsteroidal antiinflammatory drugs. At increasing pain level initial doses of oral opioids are added. In severe bone pain, where conventional therapy seems difficult, opioids are administered by invasive techniques. In localised bone pain palliative radiation is the first treatment of choice. Corticosteroids induce an analgetic effect indirectly by reducing the inflammatory oedema, inhibiting the synthesis of prostaglandins and may inhibit excitatory nerve fibres. Endocrine treatment, calcitonin and biophosphonates have shown a documented pain-relieving effect in patients with disseminated breast and prostate cancer. Chemotherapy has shown a pain-relieving effect in patients with disseminated breast cancer, surgical intervention is used in stabilizing osteolytic bones before or after a fracture ensuring a reasonable relief of pain.

Analgesics, Opioid↗