Long-term continuous subcutaneous infusion of ketoprofen combined with morphine: A safe and effective approach to cancer pain

Nora Maria Moselli, Mariaenrica Cruto, Paolo Massucco, Maurizio Savojardo, Felicino Debernardi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. METHODS: Ketoprofen was added to morphine CSI in 172 consecutive patients (study group, SG). Concomitantly, 48 received opioids CSI without ketoprofen for contraindication to NSAIDs (control group, CG). CSI was delivered through a single-use elastomeric pump refilled weekly. Safety was evaluated according to the number of adverse events and their severity. The measures of efficacy were pain relief (NRS, Numerical Rating Scale), percentage of patients that needed to increase morphine dosage, and median relative increase between weeks 2 and 4. RESULTS: Toxicity typically attributable to NSAIDs were recorded in 4.1% of patients after 3 months of treatment and the combination of NSAIDs and corticosteroids seems not to influence the risk of gastrointestinal adverse effects. The local side effects related to the CSI regimen were negligible in both the groups. By the fourth week, pain was well controlled (NRS 0 to 2) in 80% of patients receiving ketoprofen compared with 46% of patients without ketoprofen (P

Original languageEnglish
Pages (from-to)267-274
Number of pages8
JournalClinical Journal of Pain
Volume26
Issue number4
DOIs
Publication statusPublished - May 2010

Fingerprint

Ketoprofen
Subcutaneous Infusions
Morphine
Anti-Inflammatory Agents
Opioid Analgesics
Pharmaceutical Preparations
Safety
Pain
Drug and Narcotic Control
Analgesics
Adrenal Cortex Hormones
Cancer Pain
Guidelines
Control Groups

Keywords

  • Cancer pain
  • Continuous subcutaneous infusion
  • Ketoprofen
  • NSAIDs
  • Opioids

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

@article{18124f32a20e4de08fadc198e9d068c8,
title = "Long-term continuous subcutaneous infusion of ketoprofen combined with morphine: A safe and effective approach to cancer pain",
abstract = "According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. METHODS: Ketoprofen was added to morphine CSI in 172 consecutive patients (study group, SG). Concomitantly, 48 received opioids CSI without ketoprofen for contraindication to NSAIDs (control group, CG). CSI was delivered through a single-use elastomeric pump refilled weekly. Safety was evaluated according to the number of adverse events and their severity. The measures of efficacy were pain relief (NRS, Numerical Rating Scale), percentage of patients that needed to increase morphine dosage, and median relative increase between weeks 2 and 4. RESULTS: Toxicity typically attributable to NSAIDs were recorded in 4.1{\%} of patients after 3 months of treatment and the combination of NSAIDs and corticosteroids seems not to influence the risk of gastrointestinal adverse effects. The local side effects related to the CSI regimen were negligible in both the groups. By the fourth week, pain was well controlled (NRS 0 to 2) in 80{\%} of patients receiving ketoprofen compared with 46{\%} of patients without ketoprofen (P",
keywords = "Cancer pain, Continuous subcutaneous infusion, Ketoprofen, NSAIDs, Opioids",
author = "Moselli, {Nora Maria} and Mariaenrica Cruto and Paolo Massucco and Maurizio Savojardo and Felicino Debernardi",
year = "2010",
month = "5",
doi = "10.1097/AJP.0b013e3181c20221",
language = "English",
volume = "26",
pages = "267--274",
journal = "Clinical Journal of Pain",
issn = "0749-8047",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Long-term continuous subcutaneous infusion of ketoprofen combined with morphine

T2 - A safe and effective approach to cancer pain

AU - Moselli, Nora Maria

AU - Cruto, Mariaenrica

AU - Massucco, Paolo

AU - Savojardo, Maurizio

AU - Debernardi, Felicino

PY - 2010/5

Y1 - 2010/5

N2 - According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. METHODS: Ketoprofen was added to morphine CSI in 172 consecutive patients (study group, SG). Concomitantly, 48 received opioids CSI without ketoprofen for contraindication to NSAIDs (control group, CG). CSI was delivered through a single-use elastomeric pump refilled weekly. Safety was evaluated according to the number of adverse events and their severity. The measures of efficacy were pain relief (NRS, Numerical Rating Scale), percentage of patients that needed to increase morphine dosage, and median relative increase between weeks 2 and 4. RESULTS: Toxicity typically attributable to NSAIDs were recorded in 4.1% of patients after 3 months of treatment and the combination of NSAIDs and corticosteroids seems not to influence the risk of gastrointestinal adverse effects. The local side effects related to the CSI regimen were negligible in both the groups. By the fourth week, pain was well controlled (NRS 0 to 2) in 80% of patients receiving ketoprofen compared with 46% of patients without ketoprofen (P

AB - According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. METHODS: Ketoprofen was added to morphine CSI in 172 consecutive patients (study group, SG). Concomitantly, 48 received opioids CSI without ketoprofen for contraindication to NSAIDs (control group, CG). CSI was delivered through a single-use elastomeric pump refilled weekly. Safety was evaluated according to the number of adverse events and their severity. The measures of efficacy were pain relief (NRS, Numerical Rating Scale), percentage of patients that needed to increase morphine dosage, and median relative increase between weeks 2 and 4. RESULTS: Toxicity typically attributable to NSAIDs were recorded in 4.1% of patients after 3 months of treatment and the combination of NSAIDs and corticosteroids seems not to influence the risk of gastrointestinal adverse effects. The local side effects related to the CSI regimen were negligible in both the groups. By the fourth week, pain was well controlled (NRS 0 to 2) in 80% of patients receiving ketoprofen compared with 46% of patients without ketoprofen (P

KW - Cancer pain

KW - Continuous subcutaneous infusion

KW - Ketoprofen

KW - NSAIDs

KW - Opioids

UR - http://www.scopus.com/inward/record.url?scp=77951471934&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951471934&partnerID=8YFLogxK

U2 - 10.1097/AJP.0b013e3181c20221

DO - 10.1097/AJP.0b013e3181c20221

M3 - Article

C2 - 20393260

AN - SCOPUS:77951471934

VL - 26

SP - 267

EP - 274

JO - Clinical Journal of Pain

JF - Clinical Journal of Pain

SN - 0749-8047

IS - 4

ER -