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Biomedical subjects

Per Sjøgren

Publications and source records attributed to Per Sjøgren.

At least 19 recordsLinked to original sources
PubMed2006

[The medicine and drug-abusing patient].

Opioids are frequently used in chronic cancer and non-cancer pain conditions. Addiction may develop during long-term opioid treatment and illegally as intravenous "street" addiction. Benzodiazepines are frequently used for legal indications. However, due to widespread misuse efforts are being made to limit consumption. Finally, an increasing number of illegal drugs--sedatives as well as psychoactive drugs--have recently been introduced to the illegal market. This review gives guidelines for the perioperative management of patients using and misusing these drugs.

Benzodiazepines↗
PubMed2006

Addiction to opioids in chronic pain patients: a literature review.

Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria, incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid treatment as addiction may result in poor pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer pain management are concerned with the fact that pain may be under treated because of fear of addiction, and the guidelines in management of non-malignant pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during long-term opioid treatment, and specialised treatment facilities for pain management or addiction medicine should be consulted in these cases.

Analgesics, Opioid↗
PubMed2006

Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark.

AIM: To investigate health-related quality of life (HRQOL) in a nationally representative sample of long-term breast cancer survivors (BCS) in Denmark. PARTICIPANTS AND METHODS: An age-stratified random sample of 2,000 female BCS > or = 5 years after primary surgery without recurrence was drawn from the Danish Breast Cancer Cooperative Group register, which is representative regarding long-term BCS in Denmark, and compared with 3,104 women of the nationally representative Danish Health and Morbidity Survey 2000. The Short Form-36 questionnaire assessed HRQOL and its association with BCS' sociodemography, type of surgery, systemic therapy, radiotherapy, time since operation, receptor status, and low/high risk protocol. RESULTS: The response rate was 79%. BCS tended to rate HRQOL better than the general female population. BCS reported significantly less "bodily pain" (P < 0.0001), better "general health" (P < 0.0001), but worse "mental health" (P < 0.0001). Age interacted significantly with four other subscales (P < 0.05): Younger BCS reported worse HRQOL than equally aged women of the general population, while older BCS reported better HRQOL. Poor HRQOL was significantly associated with being single (all subscales: P < 0.05), short education (all subscales: P < 0.05, except "social function"), and high body mass index ("physical function", "role physical": P < 0.05). Breast cancer (low/high risk, receptor status) and treatment did not affect HRQOL. CONCLUSION: HRQOL was similar between BCS and women of the general population. Potential long-term effects of breast cancer (low/high risk, receptor status) and treatment did not seem to impact HRQOL. However, predictors for worse HRQOL in BCS were being single, and having a short education.

Adolescent↗
PubMed2006

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study.

BACKGROUND: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. METHODS: Patients were assessed at referral (T(0)) and after a treatment period of 3 months (T(3)) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T(0) to T(3) was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. RESULTS: Thirty-three patients were assessed at T(0) and 27 at T(3). The prevalence of BTP declined significantly from T(0) (90%) to T(3) (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T(0) to T(3.) The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). CONCLUSION: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.

Administration, Oral↗
PubMed2006

Critical issues on opioids in chronic non-cancer pain: an epidemiological study.

The aim of the study was epidemiologically to evaluate the long-term effects of opioids on pain relief, quality of life and functional capacity in long-term/chronic non-cancer pain. The study was based on data from the 2000 Danish Health and Morbidity Survey. As part of a representative National random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health-related quality of life (SF-36), use of the health care system, functional capabilities, satisfaction with medical pain treatment and regular or continuous use of medications. Participants reporting pain were divided into opioid and non-opioid users. The analyses were adjusted for age, gender, concomitant use of anxiolytics and antidepressants and pain intensity. Pain relief, quality of life and functional capacity among opioid users were compared with non-opioid users. Opioid usage was significantly associated with reporting of moderate/severe or very severe pain, poor self-rated health, not being engaged in employment, higher use of the health care system, and a negative influence on quality of life as registered in all items in SF-36. Because of the cross-sectional nature causative relationships cannot be ascertained. However, it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfil any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity.

Adolescent↗
PubMed2006

[Epidemiological factors relating to long-term/chronic non-cancer pain in Denmark].

The prevalence rate of chronic non-cancer pain in Denmark is about 19%. The incidence rate of development of chronic pain is also high, 1.8% per year. Risk factors for belonging to the chronic pain population and for developing chronic pain are female gender, low educational status, poor self-rated health and age. Individuals reporting long-lasting pain use the health care system (primary and secondary sectors) about twice as much as individuals without pain. The annual number of working days lost due to chronic pain is estimated at about 1,000,000.

Adolescent↗
PubMed2006

[Cancer-related pain].

Pain is not the most frequent symptom in cancer patients, but it is considered the most serious and threatening symptom. Opioid analgesics are the mainstay for analgesic treatment of cancer patients. Methadone is increasingly being considered as an alternative to morphine and seems to become relatively more potent with increasing exposure to other opioids. "Newer" side effects of opioids have been demonstrated, including cognitive impairment, generalized allodynia/hyperalgesia, myoclonus and hallucinations. When the pain relief effects of oral opioids have been exhausted, other pain management approaches, including spinal delivery of analgesics, may be effective alternatives.

Analgesics, Non-Narcotic↗
PubMed2004

Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre.

The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex matched healthy volunteers (N=64). Furthermore four subgroups of patients were examined: Group 1 (N=21) received no pain medications, group 2 (N=19) were in long-term oral opioid treatment, group 3 (N=18) were treated with antidepressants and/or anticonvulsants and group 4 (N=33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in chronic non-malignant patients.

Adult↗
PubMed2004

Pharmacological consequences of long-term morphine treatment in patients with cancer and chronic non-malignant pain.

BACKGROUND: In patients with pain of malignant origin morphine may be administered in high and often increasing doses during extended periods of time. In patients with chronic pain of non-malignant origin morphine may be an important remedy, and in these cases the goal is to keep the morphine dose stable. The pharmacokinetic as well as the pharmacodynamic consequences of long-term morphine treatment with special reference to the two most important metabolites of morphine morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G) remain to be settled. METHODS: Assessments for pain, sedation and other morphine induced side effects were made several times for 19 cancer patients treated with changing doses of oral sustained release (SR) morphine and twice for 17 non-cancer patients treated with stable doses of SR morphine. Blood samples were obtained simultaneously and analysed for contents of 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 (r = 0.469, p < 0.01), plasma M-6-G (r = 0.677, p < 0.01), and plasma M-3-G ((r = 0.827, p < 0.01), in the cancer patient group, but only between the daily dose of SR morphine and plasma M-3-G (0.662, p < 0.01) and plasma M-6-G (0.571, p < 0.01) in the non-cancer patient group. Normalised M-3-G/M and M-6-G/M ratios for the cancer patient group were independent of duration of treatment and daily dose of SR morphine. Likewise in the non-cancer patient group duration of treatment did not influence the metabolite ratios. Correlations between pain score and plasma morphine, M-6-G and M-6-G/M were weak in the cancer patient as well as in the non-cancer patient group making it impossible to draw any conclusion regarding the potential contributory analgesic effect of M-6-G. Dryness of the mouth was the most frequent adverse effect reported in the non-cancer as well as the cancer patient group. In the latter group patients complaining of dryness of the mouth had significantly higher plasma morphine and M-6-G concentrations than patients who did not suffer from this side effect. This difference persisted (or was close to significance) when excluding patients receiving antidepressants. CONCLUSION: In the cancer patient group neither dose nor treatment period seems to influence morphine glucuronidation. Likewise in the non-cancer patient group receiving stable doses of morphine duration of treatment does not seem to influence morphine glucuronidation. Dryness of the mouth was positively correlated to high plasma concentrations of morphine and M-6-G.

Adult↗
PubMed2004

Health care utilisation among individuals reporting long-term pain: an epidemiological study based on Danish National Health Surveys.

Individuals reporting long-term pain in the 1994 and 2000 Danish Health and Morbidity Surveys, which included random samples of 6000 and 16,684 persons respectively, were investigated concerning their use of the health care systems. A considerably higher use was observed in the pain population in the primary as well as the secondary health care sector, compared with a no pain control group. In 1994, individuals reporting long-term pain had on average 12.8 contacts per year to the primary health care sector compared with 7.3 for the control group. Use of secondary health care sector as estimated by hospital admission frequency and number of in-hospital days was not only significantly higher for the pain group but showed also an increasing tendency during the periods investigated (1991-1997). Women used the health care system significantly more than men, whereas age did not seem to influence. In conclusion, individuals reporting long-term/chronic pain have a significantly higher use of the health care system than individuals without long-term/chronic pain complaints. Reasons may be ascribed to within-patient factors, factors within the health care system (insufficient knowledge on chronic pain resulting in the seeking after a somatic diagnosis, and difficulties in recognizing the endpoint of reasonable treatment attempts), and societal factors (legislation on disability and compensation).

Adolescent↗
PubMed2004

Development of and recovery from long-term pain. A 6-year follow-up study of a cross-section of the adult Danish population.

A 6-year follow-up study of a cross-section of the adult Danish population, based on data from the Danish Health and Morbidity Surveys in 1994 and 2000 is presented. The pain populations were identified through the pain intensity verbal rating scale (VRS) included in the Short Form 36. The 2000 survey also included a question on duration of pain (>6 months). Using this as the 'gold standard', a validation study was performed, which identified the highest accuracy (85%) at the VRS cut-off level: no pain, very mild, or mild pain (control group) versus moderate, severe, or very severe pain (pain group). The cohort comprised 2649 individuals, representative of the Danish population. Prevalence rates of pain in 1994 and 2000 were 13.5 and 15.7%, respectively. The cumulated 6-year incidence of pain development was 10.7%, and the cumulated incidence of pain recovery was 52.1%. During the investigated period, 9.2% of individuals moved from a 'no pain status' to a 'pain status', 7% moved from a 'pain status' to a 'no pain status', and 6.5% maintained their 'pain status'. Significant risk factors for pain development were female gender [odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-2.0], short education (OR 1.5, CI 1.0-2.2), poor self-rated health (OR 3.3, CI 2.4-4.7), and having at least one long-standing disease (OR 2.6, CI 2.0-3.4). Significant predictors for pain recovery were male gender, younger age, cohabitation status, good self-rated health, good mental health, having no long-standing disease, and having an annual income above 15,400 US dollars.

Adolescent↗
PubMed2004

Identifying a long-term/chronic, non-cancer pain population using a one-dimensional verbal pain rating scale: an epidemiological study.

The usefulness of the verbal pain rating scale (VRS) included in the Short Form 36 (SF-36) in identifying characteristics of long-term pain conditions, was analyzed using data from the 1994 Danish Health and Morbidity Survey. Based on the rating of pain intensity during a 4-week recall period the respondents were categorized into three groups: a high pain group (HPG) consisting of persons reporting moderate to severe pain (VRS 4-6), a low pain group (LPG) who rated their pain as very mild or mild (VRS 2-3), and a control group (CG) with no pain (VRS 1). The investigated sample comprised 3992 persons (HPG=563 persons, LPG=1714, and CG=1715 persons). Older age, educational level (< 10 years of schooling), cohabitation status (divorce/separation), and moderate to severe physical job strain were found to be significant risk factors for reporting high pain intensity (HPG). Only minor differences were observed between the LPG and CG. The proportion of respondents with good perceived health was significantly lower in the HPG compared with LPG and CG. The dominant complaints in the HPG were related to the musculoskeletal system. During a 14-day period prior to the interview persons in the HPG had a mean of 1.19 working days lost due to illness compared with a mean of 0.2 for the LPG and CG. Analyzing the use of medical services during the year before the interview, persons belonging to the HPG had an average number of nine contacts to general practitioners and specialized doctors in the primary sector as compared to six for the LPG and four for the CG. Mean numbers of hospital admissions were 0.29 for the HPG, 0.15 for the LPG and 0.10 for the CG. Mean numbers of in-hospital days were 1.60, 0.80, and 0.43 for the HPG, LPG, and CG, respectively. Our study suggest that one-dimensional pain intensity scoring using a simple VRS-scoring is useful as a screening instrument for identifying persons suffering from pain of a more complex nature. High intensity scores on a pain intensity scale should indicate to the investigator that she/he might be facing a person whose pain complaints and behavior are not only based on a pure biological background, but in whom also severe psychological and social problems might be present.

Adolescent↗
PubMed2003

Epidemiology of chronic non-malignant pain in Denmark.

A series of health surveys are conducted every sixth to seventh year in Denmark. In the most recent survey of 2000, a national random sample (>16 years) was drawn from the Danish Central Personal Register. Out of the original sample 12,333 (74%) were interviewed and of these 10,066 returned a completed questionnaire (SF-36). The present study includes only those who both took part in the interview and the postal questionnaire. Cancer patients were excluded. Persons suffering from chronic pain (PG) were identified through the question 'Do you have chronic/long lasting pain lasting 6 months or more'? An overall chronic pain prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16-24 years. Compared with married persons, divorced or separated persons had 1.5 higher odds of chronic pain. Odds for chronic pain were 1.9 higher among those with an education of less than 10 years compared with individuals with an education of 13 years or more. During a 14-day period reporters of chronic pain had an average of 0.8 days (range 0-10) lost due to illness compared with an average of 0.4 days (range 0-10) for the control group (CG) (Odds Ratio (OR)) 2.0). Persons with a job which required high physical strain were more likely to report chronic pain compared with those with a sedentary job (OR 2.2). The odds of quitting one's job because of ill health were seven times higher among people belonging to the PG. A strong association between chronic pain and poor self-rated health was also demonstrated. The PG had twice as many contacts with various health professionals compared with the CG, and the health care system was, on average, utilised 25% more (overall contacts) by the PG than by the general population. Among the persons in the PG, 33% were not satisfied with the examinations carried out in connection with their pain condition and 40% were not satisfied with the treatment offered. Nearly 130,000 adults, corresponding to 3% of the Danish population, use opioids on a regular basis. Opioids are used by 12% of the PG.

Adolescent↗
PubMed2003

Relationships among morphine metabolism, pain and side effects during long-term treatment: an update.

The two metabolites of morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), have been studied intensively in animals and humans during the past 30 years in order to elucidate their precise action and possible contribution to the desired effects and side effects seen after morphine administration. M3G and M6G are formed by morphine glucuronidation, mainly in the liver, and are excreted by the kidneys. The metabolites are found in the cerebrospinal fluid after single as well as multiple doses of morphine. M6G binds to opioid receptors, and animal studies have demonstrated that M6G may be a more potent analgesic than morphine. Results from human studies regarding the analgesic effect of M6G are not unanimous. The potency ratio between systemic M6G and morphine in humans has not been settled, but is probably lower than previously assumed. Hitherto, only a few studies have found evidence for a contributory effect of M6G to the overall effects observed after morphine administration. Several studies have demonstrated that administration of M6G is accompanied by fewer and a milder degree of opioid-like side effects than observed after morphine administration, but most of the studies have used lower doses of M6G than of morphine. M3G displays very low affinity for opioid receptors and has no analgesic activity. Animal studies have shown that M3G may antagonize the analgesic effect of morphine and M6G, but no human studies have demonstrated this. M3G has also been connected to certain neurotoxic symptoms, such as hyperalgesia, allodynia and myoclonus, which have been observed after administration of M3G or high doses of morphine in animals. The symptoms have been reported sporadically in humans treated primarily with high doses of morphine, but the role of M3G in eliciting the symptoms is not fully elucidated.

Analgesics, Opioid↗
PubMed2002

Changing M3G/M6G ratios and pharmacodynamics in a cancer patient during long-term morphine treatment.

A cancer patient receiving long-term oral sustained-release morphine treatment and periodically presenting with unusually high plasma M3G/M6G ratios is described. We found the patient's formation of M6G more unstable and perhaps delayed compared to the formation of M3G. There is no apparent explanation for this phenomenon and the high M3G/M6G ratios had no implications for the patient's pain experience or side effects from the morphine treatment.

Analgesics, Opioid↗