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Roussin A, Cissé Z, Rousseau V, Roche G, Lestrade C, Cauchie A, Delage N, Donnet A, Van Obberghen E, Wood C, Lapeyre-Mestre M, Cantagrel N. Discordance between pain specialists and patients on the perception of dependence on pain medication: A multi-centre cross-sectional study. Therapie 2024:S0040-5957(24)00043-X. [PMID: 38653623 DOI: 10.1016/j.therap.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 04/25/2024]
Abstract
AIM Patients with chronic non-cancer pain are referred to pain centres to improve their pain treatment. The discontinuation of pain medications in case of poor efficacy can be difficult to accept for patients, particularly opioid analgesics. Previous research has described that from the patients' perspective, the psychological relief of a negative effect of chronic pain and withdrawal symptoms of prescription opioids represent drivers of persistent use and first stage of opioid use disorder, despite insufficient pain relief. There is no validated tool to investigate this psychological dependence. This study aimed to assess discordance between patients and pain specialists in their perception of dependence on pain medication and investigate associations with characteristics of patients, type of pain and iatrogenic pharmacodependence. METHODS Self-administered questionnaires (patients and physicians) were administered in six pain centres in France. A question on perceived dependence on pain medications was addressed to the patient and the physician in a matched pair. Discordance between them was evaluated by the Cohen kappa coefficient. Demographics, pain, anxiety and depression, pain medication withdrawal symptoms, diverted use, and craving represented variables studied in a multivariate model as potentially associated with patient-physician discordance. RESULTS According to the 212 pairs of completed questionnaires, a perceived dependence was reported by the majority of patients (65.6%) and physicians (68.4%). However, the concordance was fair (kappa=0.38; CI [95%]: 0.25-0.51). Almost all patients (89.3%) were treated with an opioid analgesic. A higher likelihood of discordance was observed when patients suffered from nociplastic pain (odds ratio [OR]: 2.72, 95% [CI]: 1.29-5.84). CONCLUSION Medical shared-decision for changing pain treatment could be improved by taking into account the perception of patient dependence on medications for pain relief and or psychoactive effects, particularly in nociplastic pain for which the treatment is challenging.
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Affiliation(s)
- Anne Roussin
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France.
| | - Zénab Cissé
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Vanessa Rousseau
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France
| | - Guillaume Roche
- Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
| | - Alexandre Cauchie
- Centre d'évaluation et de traitement de la douleur, pôle neurosciences cliniques, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Timone Hospital, 13005 Marseille, France
| | - Elise Van Obberghen
- Pain Department, CHU de Nice, France - FHU InovPain, université Côte d'Azur, 06000 Nice, France; Department of Pharmacology and Toxicology, PharmacoVigilance Centre, University of Nice Medical Centre, 06000 Nice, France
| | - Chantal Wood
- Centre d'évaluation et de traitement de la douleur, Limoges University Hospital, 87042 Limoges, France
| | - Maryse Lapeyre-Mestre
- Pharmacologie en population cohortes et biobanques, centre d'investigation clinique 1436, Toulouse University Hospital, 31059 Toulouse, France; Département de pharmacologie clinique et médicale, centre d'addictovigilance, Toulouse University Hospital, 31000 Toulouse, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Toulouse University Hospital, 31059 Toulouse, France
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Laporte C, Fortin F, Dupouy J, Quirin A, Pereira B, Chenaf C, Delorme J, Maynié-François C, Rat C, Birebent J, Rambaud J, Duale C, Kerckhove N, Delage N, Authier N. Real-Life Testing of the Prescription Opioid Misuse Index in French Primary Care. Int J Environ Res Public Health 2022; 19:14845. [PMID: 36429565 PMCID: PMC9690529 DOI: 10.3390/ijerph192214845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Analgesic opioid (AO) misuse by patients ranges from 0% to 50%. General practitioners are the first prescribers of AO. Our objective was to validate the Prescription Opioid Misuse Index (POMI) in primary care. We conducted a psychometric study in patients with chronic pain who had been taking AOs for at least 3 months and were followed in general practice. Patients responded to the POMI at inclusion and after 2 weeks. The reference used was the DSM-V. Sixty-nine GPs included 160 patients (87 women, 54.4%), mean age 56.4 ± 15.2 years. The total POMI score was 1.50 ± 1.27, and 73/160 (45.6.0%) had a score ≥ 2 (misuse threshold). Internal validity was measured with the Kuder-Richardson coefficient, which was 0.44. Correlations between each item and the total score ranged from 0.06 to 0.35. Test-retest reliability was determined from 145 patients: Lin's concordance coefficient was 0.57 [0.46, 0.68]. Correlation with the DSM-V (Spearman's coefficient) was 0.52. The POMI does not have sufficient psychometric properties to be recommended as a tool to identify the misuse of AOs in primary care. This study clearly showed that there is a need to create a monitoring tool specific to primary care.
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Affiliation(s)
- Catherine Laporte
- Clermont Auvergne Institut Pascal (INP), CNRS, Centre Hospitalo-Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Frédéric Fortin
- Clermont Auvergne Institut Pascal (INP), CNRS, Centre Hospitalo-Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Julie Dupouy
- Unite Mixte de Recherche (UMR) 1295 Inserm, Université Toulouse III, F-31000 Toulouse, France
- Maison de Santé Pluriprofessionelle Universitaire de Pins Justaret, F-31860 Pins Justaret, France
| | - Aurélie Quirin
- Clermont Auvergne Institut Pascal (INP), CNRS, Centre Hospitalo-Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques, Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Chouki Chenaf
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Centre d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Jessica Delorme
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Centre d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Christine Maynié-François
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive (LBBE), Équipe Evaluation et Modélisation des Effets Thérapeutiques (EMET), Université Claude Bernard Lyon 1, F-69100 Lyon, France
| | - Cédric Rat
- Département de Médecine Générale, Université de Nantes-INSERM U1302/CNRS EMR6001-Équipe 2, F-44035 Nantes, France
| | - Jordan Birebent
- Unite Mixte de Recherche (UMR) 1295 Inserm, Université Toulouse III, F-31000 Toulouse, France
- Maison de Santé Pluriprofessionelle Universitaire de Pins Justaret, F-31860 Pins Justaret, France
| | - Jacques Rambaud
- Département de Médecine Générale, Université Montpellier, F-34090 Montpellier, France
| | - Christian Duale
- Unité de Biostatistiques, Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Nicolas Kerckhove
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Centre d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Noémie Delage
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Centre d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Centre d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
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Kerckhove N, Delage N, Bertin C, Kuhn E, Cantagrel N, Vigneau C, Delorme J, Lambert C, Pereira B, Chenaf C, Authier N. Cross-sectional study of the prevalence of prescription opioids misuse in French patients with chronic non-cancer pain: An update with the French version of the POMI scale. Front Pharmacol 2022; 13:947006. [PMID: 36133827 PMCID: PMC9484362 DOI: 10.3389/fphar.2022.947006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Public health issues related to chronic pain management and the risks of opioid misuse and abuse remain a challenge for practitioners. Data on the prevalence of disorders related to the use of prescribed opioids in patients suffering from chronic pain remains rather patchy, in particular because of the absence of a gold standard for their clinical assessment. We estimated the prevalence of prescription opioid misuse (POM), using a specific and validated opioid misuse scale (POMI-5F scale), in adults with chronic non-cancer pain. Nine-hundred-fifty-one (951) patients with opioids prescription and followed-up in pain clinics and addictology centers for chronic non-cancer pain (CNCP) completed the survey interview. The results suggest that 44.4% of participants have POM, accompanied by overuse (42.5%), use of opioids for effects other than analgesia (30.9%), withdrawal syndrome (65.7%), and craving (6.9%). The motivations cited for POM, apart from pain relief, were to calm down, relax and improve mood. POM was shown to be related to male sex (OR 1.52), young age (OR 2.21) and the presence of nociplastic pain (OR 1.62) of severe intensity (OR 2.31), codeine use (OR 1.72) and co-prescription of benzodiazepines (OR 1.59). Finally, despite the presence of three subgroups of misusers, no factor was associated with the intensity of misuse, reinforcing the view that distinguishing between strong and weak opioids is not appropriate in the context of use disorder. Almost half of patients with CNCP misuse their prescribed opioid. Practitioners should be attentive of profiles of patients at risk of POM, such as young, male patients suffering from severe nociplastic pain, receiving prescription for codeine and a co-prescription for benzodiazepine. We encourage French-speaking practitioners to use the POMI-5F scale to assess the presence of POM in their patients receiving opioid-based therapy. Clinical Trial Registrationclinicaltrials.gov, identifier NCT03195374
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- *Correspondence: Nicolas Kerckhove,
| | - Noémie Delage
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuelle Kuhn
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Nathalie Cantagrel
- Centre d’Evaluation et de Traitement de la Douleur, CHU Toulouse, Toulouse, France
| | - Caroline Vigneau
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Jessica Delorme
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Kerckhove N, Delage N, Cambier S, Cantagrel N, Serra E, Marcaillou F, Maindet C, Picard P, Martiné G, Deleens R, Trouvin AP, Fourel L, Espagne-Dubreuilh G, Douay L, Foulon S, Dufraisse B, Gov C, Viel E, Jedryka F, Pouplin S, Lestrade C, Combe E, Perrot S, Perocheau D, De Brisson V, Vergne-Salle P, Mertens P, Pereira B, Djiberou Mahamadou AJ, Antoine V, Corteval A, Eschalier A, Dualé C, Attal N, Authier N. eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study. JMIR Form Res 2022; 6:e30052. [PMID: 35234654 PMCID: PMC8928045 DOI: 10.2196/30052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. TRIAL REGISTRATION ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694.
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Noémie Delage
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Cambier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Cantagrel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric Serra
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Fabienne Marcaillou
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Maindet
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pascale Picard
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaelle Martiné
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Rodrigue Deleens
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Anne-Priscille Trouvin
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Lauriane Fourel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Gaelle Espagne-Dubreuilh
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Ludovic Douay
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Stéphane Foulon
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Bénédicte Dufraisse
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Christian Gov
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Eric Viel
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - François Jedryka
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Sophie Pouplin
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Cécile Lestrade
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Combe
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Perrot
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Dominique Perocheau
- Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Cochin, Paris, France
| | - Valentine De Brisson
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Régional de Bayeux, Bayeux, France
| | - Pascale Vergne-Salle
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Patrick Mertens
- Centre d'évaluation et de traitement de la douleur, Hospices Civils de Lyon Pierre Wertheimer, Lyon, France
| | - Bruno Pereira
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Violaine Antoine
- Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes, Université Clermont Auvergne, Aubière, France
| | | | | | - Christian Dualé
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadine Attal
- Institut National de la Santé et de la Recherche Médicale, Unité 987 - Centre d'évaluation et de traitement de la douleur, Assistance Publique-Hôpitaux de Paris Ambroise Paré, Paris, France
| | - Nicolas Authier
- Centre d'évaluation et de traitement de la douleur, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Delorme J, Bertin C, Delage N, Eschalier A, Ardid D, Authier N, Chenaf C. Prevalence of chronic pain in opioid-maintained patients using the capture-recapture method: a nationwide population-based study. Pain 2021; 162:195-202. [PMID: 32701648 DOI: 10.1097/j.pain.0000000000002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few studies all based on classical surveys have provided prevalence estimates of chronic pain (CP) in opioid-maintained patients (OMPs) but often had a limited patient sample size and a great variability in the prevalence estimates. This study sought to assess the prevalence of CP in the exhaustive population of OMPs using the capture-recapture method applied to the French nationwide health care database. Capture-recapture methods are increasingly used to estimate the prevalence of chronic conditions but have never been used in the specific context of CP in OMPs. Three large medical-administrative sources were used: the prescription drug database (A-list), the national hospital discharge database (M-list), and the pain center database (C-list). Between 2015 and 2016, 160,429 OMPs aged 15 years and older were identified and age- and sex-matched with 160,429 non-OMPs. All patients treated with analgesic drugs for ≥6 months (A-list) or diagnosed with CP (M- and C-list) were included. Capture-recapture analyses were performed to yield CP estimates with their 95% confidence intervals using log-linear models. In 2015 to 2016, 12,765 OMPs and 2938 non-OMPs with CP were captured. Most patients were male (67%) in OMPs and non-OMPs; median ages for OMPs and non-OMPs were 46 (interquartile range: 38-51) and 48 (41-53) years, respectively. The CP prevalence estimated in OMPs and non-OMPs ranged from 23.6% (14.9-46.2) to 32.1% (28.6-36.3) and from 7.28% (3.98-18.4) to 9.32% (7.42-12.1), respectively. This first study on CP in the exhaustive population of OMPs using the capture-recapture method demonstrated a high prevalence of CP in OMPs, 3- to 4-fold than in the general population.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Noémie Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne-CHU Clermont-Ferrand, F-63001 Clermont-Ferrand, France
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Bertin C, Delage N, Rolland B, Pennel L, Fatseas M, Trouvin AP, Delorme J, Chenaf C, Authier N. Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management. Neurosci Biobehav Rev 2020; 121:160-174. [PMID: 33358994 DOI: 10.1016/j.neubiorev.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.
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Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France; Fondation Institut Analgesia, Faculté de Médecine, F-63001, Clermont-Ferrand, France.
| | - Noémie Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Université de Lyon, UCBL1, INSERM U1028, CNRS UMR 5292, Bron, France
| | - Lucie Pennel
- Service Universitaire de Pharmaco-Addictologie - CSAPA, CHU Grenoble Alpes, UFR de médecine, Université Grenoble-Alpes, 38043 Grenoble, France
| | - Mélina Fatseas
- University of Bordeaux, 33076 Bordeaux Cedex, France; CNRS-UMR 5287- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France; CHU de Bordeaux, France
| | - Anne-Priscille Trouvin
- Centre d'Evaluation et Traitement de la Douleur, Université Paris Descartes, Hôpital Cochin, Paris, France; U987, INSERM, Boulogne Billancourt, France
| | - Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France; Fondation Institut Analgesia, Faculté de Médecine, F-63001, Clermont-Ferrand, France
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7
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Martin E, Sorel M, Morel V, Marcaillou F, Picard P, Delage N, Tiberghien F, Crosmary MC, Najjar M, Colamarino R, Créach C, Lietar B, Brumauld de Montgazon G, Margot-Duclot A, Loriot MA, Narjoz C, Lambert C, Pereira B, Pickering G. Dextromethorphan and memantine after ketamine analgesia: a randomized control trial. Drug Des Devel Ther 2019; 13:2677-2688. [PMID: 31447547 PMCID: PMC6683947 DOI: 10.2147/dddt.s207350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/05/2019] [Indexed: 01/05/2023]
Abstract
Purpose Intravenous ketamine is often prescribed in severe neuropathic pain. Oral N-methyl-D-aspartate receptor (NMDAR) antagonists might prolong pain relief, reducing the frequency of ketamine infusions and hospital admissions. This clinical trial aimed at assessing whether oral dextromethorphan or memantine might prolong pain relief after intravenous ketamine. Patients and methods A multicenter randomized controlled clinical trial included 60 patients after ketamine infusion for refractory neuropathic pain. Dextromethorphan (90 mg/day), memantine (20 mg/day) or placebo was given for 12 weeks (n=20 each) after ketamine infusion. The primary endpoint was pain intensity at one month. Secondary endpoints included pain, sleep, anxiety, depression, cognitive function and quality of life evaluations up to 12 weeks. Results At 1 month, dextromethorphan maintained ketamine pain relief (Numeric Pain Scale: 4.01±1.87 to 4.05±2.61, p=0.53) and diminished pain paroxysms (p=0.03) while pain intensity increased significantly with memantine and placebo (p=0.04). At 3 months, pain remained lower than at inclusion (p=0.001) and was not significantly different in the three groups. Significant benefits were observed on cognitive-affective domains and quality of life for dextromethorphan and memantine (p<0.05). Conclusions Oral dextromethorphan given after ketamine infusion extends pain relief during one month and could help patients to better cope with pain. Future studies should include larger populations stratified on pharmacogenetics screening. Optimization of an oral drug that could extend ketamine antihyperalgesia, with fewer hospital admissions, remains a prime challenge in refractory neuropathic pain.
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Affiliation(s)
- Elodie Martin
- Université Clermont Auvergne, Pharmacologie Fondamentale Et Clinique de la Douleur, Neuro-Dol, Inserm 1107, F-63000 Clermont-Ferrand, France
| | - Marc Sorel
- Centre D'evaluation et de Traitement de la Douleur/soins Palliatifs, Nemours, France
| | - Véronique Morel
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique/Centre d'investigation Clinique Inserm 1405, F-63003 Clermont-Ferrand cedex, France
| | - Fabienne Marcaillou
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, France
| | - Pascale Picard
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, France
| | - Noémie Delage
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, France
| | - Florence Tiberghien
- Centre d'evaluation et de Traitement de la Douleur/soins Palliatifs, CHU Jean Minjoz, Besançon, France
| | | | - Mitra Najjar
- Centre d'evaluation et de Traitement de la Douleur, CH Jacques Lacarin Vichy, France
| | - Renato Colamarino
- Centre d'evaluation et de Traitement de la Douleur, CH Jacques Lacarin Vichy, France
| | - Christelle Créach
- Centre d'evaluation et de Traitement de la Douleur, CHU de Saint-etienne, France.,Inserm U1028 & Umr 5292, Centre de Neurosciences de Lyon, Université Lyon & Jean-monnet De Saint-etienne, France
| | - Béatrice Lietar
- Centre d'evaluation et de Traitement de la Douleur, CHU de Saint-etienne, France
| | | | - Anne Margot-Duclot
- Centre d'evaluation et de Traitement de la Douleur, Fondation A de Rothschild, Paris, France
| | - Marie-Anne Loriot
- Service de biochimie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Inserm UMR-S 1147, Université Paris Descartes, Paris, France
| | - Céline Narjoz
- Service de biochimie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Inserm UMR-S 1147, Université Paris Descartes, Paris, France
| | - Céline Lambert
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation - Villa annexe IFSI, 58 Rue Montalembert, F-63003 Clermont-Ferrand cedex, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation - Villa annexe IFSI, 58 Rue Montalembert, F-63003 Clermont-Ferrand cedex, France
| | - Gisèle Pickering
- Université Clermont Auvergne, Pharmacologie Fondamentale Et Clinique de la Douleur, Neuro-Dol, Inserm 1107, F-63000 Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre de Pharmacologie Clinique/Centre d'investigation Clinique Inserm 1405, F-63003 Clermont-Ferrand cedex, France
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8
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Chenaf C, Kaboré JL, Delorme J, Pereira B, Mulliez A, Zenut M, Delage N, Ardid D, Eschalier A, Authier N. Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality. Eur J Pain 2018; 23:124-134. [PMID: 30051548 DOI: 10.1002/ejp.1291] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND While data from USA and Canada demonstrate an opioid overdose epidemic, very little nation-wide European studies have been published on this topical subject. METHODS Using a nationally representative sample of the French Claims database (>700,000 patients), the exhaustive nationwide hospital discharge database, and national mortality registry, all patients dispensed at least one prescription opioid (PO) in 2004-2017 were identified, to describe trends in PO analgesic use, shopping behaviour, opioid-related hospitalizations and deaths. Annual prevalence of PO use and shopping behaviour (≥1 day of overlapping prescriptions from ≥2 prescribers, dispensed by ≥3 pharmacies) was estimated. RESULTS In 2004-2017, the annual prevalence of weak opioid use codeine, tramadol and opium rose by 150%, 123%, and 244%, respectively (p < 0.05). Strong opioid use increased from 0.54% to 1.1% (+104%, p < 0.05), significantly for oxycodone (+1950%). Strong opioid use in chronic noncancer pain rose by 88% (p < 0.05) and 1180% for oxycodone. Opioid shopping increased from 0.50% to 0.67% (+34%, p < 0.05), associated with higher mortality risk HR = 2.8 [95% confidence interval (CI): 1.2-6.4]. Opioid-related hospitalizations increased from 15 to 40 per 1,000,000 population (+167%, 2000-2017), and opioid-related deaths from 1.3 to 3.2 per 1,000,000 population (+146%, 2000-2015). CONCLUSIONS This study provided a first European approach to a nationwide estimation with complete access to several national registries. In 2004-2017 in France, PO use excluding dextropropoxyphene more than doubled. The increase in oxycodone and fentanyl use, and nontrivial increasing trend in opioid-related morbidity-mortality should prompt authorities to closely monitor PO consumption in order to prevent alarming increases in opioid-related morbidity-mortality. SIGNIFICANCE In 2004-2017, prescription opioid use in France at least doubled and oxycodone use increased particularly, associated with a nontrivial increase in opioid-related morbidity-mortality. Although giving no indication for an 'opioid epidemic,' these findings call for proper monitoring of opioid use.
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Affiliation(s)
- C Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - J-L Kaboré
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - J Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France
| | - A Mulliez
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France
| | - M Zenut
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - N Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - D Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - A Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - N Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
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Pickering G, Macian N, Delage N, Picard P, Cardot JM, Sickout-Arondo S, Giron F, Dualé C, Pereira B, Marcaillou F. Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study. Drug Des Devel Ther 2018; 12:2485-2496. [PMID: 30127596 PMCID: PMC6089099 DOI: 10.2147/dddt.s162810] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Fibromyalgia is characterized by widespread and chronic pain, and its prevalence is increasing worldwide. Milnacipran, an antidepressant, is often prescribed for fibromyalgia with a possible beneficial effect on central pain modulation. The aim of this study was to evaluate if milnacipran could modify the status of conditioned pain modulation (CPM) in patients suffering from fibromyalgia. Design and setting Randomized, double-blind controlled trial. Subjects and methods Women with fibromyalgia received milnacipran 100 mg or placebo. The primary end point was the evolution of CPM with treatments after a 30-second painful stimulus. Secondary outcomes included the predictability of milnacipran efficacy from CPM performance, evolution of global pain, mechanical sensitivity, thermal pain threshold, mechanical allodynia, cognitive function, and tolerance. Results Fifty-four women with fibromyalgia (46.7±10.6 years) were included and randomized, and 24 patients were analyzed in each group. At inclusion, CPM was dysfunctional (CPM30=-0.5±1.9), and global pain was 6.5±1.8. After treatment, there was a nonsignificant CPM difference between milnacipran and placebo (CPM30=-0.46±1.22 vs -0.69±1.43, respectively, p=0.55) and 18.8% vs 6.3% (p=0.085) patients did reactivate CPM after milnacipran vs placebo. Initial CPM was not a predictor of milnacipran efficacy. Global pain, mechanical and thermal thresholds, allodynia, cognition, and tolerance were not significantly different between both groups. Conclusion Milnacipran did not display a significant analgesic effect after 1-month treatment, but the tendency of milnacipran to reactivate CPM in a number of patients must be explored with longer treatment duration in future studies and pleads for possible subtypes of fibromyalgia patients.
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Affiliation(s)
- Gisèle Pickering
- University Clermont Auvergne Neurodol, Clermont-Ferrand, France, .,Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Nicolas Macian
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Noémie Delage
- Pain Clinic, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascale Picard
- Pain Clinic, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Cardot
- University Clermont Auvergne MEDIS, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophia Sickout-Arondo
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Fatiha Giron
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Christian Dualé
- Clinical Pharmacology Department CPC/CIC Inserm 1405, University Hospital, Clermont-Ferrand, France,
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
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10
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Kerckhove N, Pereira B, Soriot-Thomas S, Alchaar H, Deleens R, Hieng VS, Serra E, Lanteri-Minet M, Arcagni P, Picard P, Lefebvre-Kuntz D, Maindet C, Mick G, Balp L, Lucas C, Creach C, Letellier M, Martinez V, Navez M, Delbrouck D, Kuhn E, Piquet E, Bozzolo E, Brosse C, Lietar B, Marcaillou F, Hamdani A, Leroux-Bromberg N, Perier Y, Vergne-Salle P, Gov C, Delage N, Gillet D, Romettino S, Richard D, Mallet C, Bernard L, Lambert C, Dubray C, Duale C, Eschalier A. Efficacy and safety of a T-type calcium channel blocker in patients with neuropathic pain: A proof-of-concept, randomized, double-blind and controlled trial. Eur J Pain 2018; 22:1321-1330. [PMID: 29577519 DOI: 10.1002/ejp.1221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND T-type calcium channels have been shown to play an important role in the initiation and maintenance of neuropathic pain and represent a promising therapeutic target for new analgesic treatments. Ethosuximide (ETX), an anticonvulsant and a T-type channel blocker has shown analgesic effect in several chronic pain models but has not yet been evaluated in patients with neuropathic pain. METHODS This proof-of-concept, multicentre, double-blind, controlled and randomized trial compared the efficacy and safety of ETX (given as add-on therapy) to an inactive control (IC) in 114 patients with non-diabetic peripheral neuropathic pain. After a 7-day run-in period, eligible patients aged over 18 years were randomly assigned (1:1) to ETX or IC for 6 weeks. The primary outcome was the difference between groups in the pain intensity (% of change from the baseline to end of treatment) assessed in the intention-to-treat population. This study is registered with EudraCT (2013-004801-26) and ClinicalTrials.gov (NCT02100046). RESULTS The study was stopped during the interim analysis due to the high number of adverse events in the active treatment group. ETX failed to reduce total pain and showed a poor tolerance in comparison to IC. In the per-protocol analysis, ETX significantly reduced pain intensity by 15.6% (95% CI -25.8; -5.4) from baseline compared to IC (-7.8%, 95% CI -14.3; -1.3; p = 0.033), but this result must be interpreted with caution because of a small subgroup of patients. CONCLUSION Ethosuximide did not reduce the severity of neuropathic pain and induces, at the doses used, many adverse events. SIGNIFICANCE This article shows that ETX is not effective to treat neuropathic pain. Nevertheless, per-protocol analysis suggests a possible analgesic effect of ETX. Thus, our work adds significant knowledge to preclinical and clinical data on the benefits of T-type calcium channel inhibition for the treatment of neuropathic pain.
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Affiliation(s)
- N Kerckhove
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France.,Analgesia Institute, Université Clermont Auvergne, Clermont-Ferrand, France
| | - B Pereira
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | | | - H Alchaar
- Université Nice Côte-d'Azur, CHU Nice - Hôpital de Cimiez, Fédération Hospitalo-Universitaire INOVPAIN, CETD, Nice, France
| | | | | | - E Serra
- CHU Amiens Picardie, CETD, CRC, Amiens, France
| | - M Lanteri-Minet
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France.,Université Nice Côte-d'Azur, CHU Nice - Hôpital de Cimiez, Fédération Hospitalo-Universitaire INOVPAIN, CETD, Nice, France
| | - P Arcagni
- CHU Saint-Etienne, CETD, Saint-Etienne, France
| | - P Picard
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | | | - C Maindet
- CHU Grenoble Alpes, CETD, Grenoble, France
| | - G Mick
- CH Voiron, UETD, Voiron, France
| | - L Balp
- CH Lons-le-Saunier, CETD, Lons-le-Saunier, France
| | - C Lucas
- Université Lille Nord de France, CHRU Lille, CETD, Lille, France
| | - C Creach
- CHU Saint-Etienne, CETD, Saint-Etienne, France
| | | | - V Martinez
- AP-HP - Hôpital Raymond Poincaré, CETD, Paris, France
| | - M Navez
- CHU Saint-Etienne, CETD, Saint-Etienne, France
| | | | - E Kuhn
- CHU Nantes, CETD, Nantes, France
| | - E Piquet
- Université Nice Côte-d'Azur, CHU Nice - Hôpital de Cimiez, Fédération Hospitalo-Universitaire INOVPAIN, CETD, Nice, France
| | - E Bozzolo
- Université Nice Côte-d'Azur, CHU Nice - Hôpital de Cimiez, Fédération Hospitalo-Universitaire INOVPAIN, CETD, Nice, France
| | - C Brosse
- CHU Saint-Etienne, CETD, Saint-Etienne, France
| | - B Lietar
- CHU Saint-Etienne, CETD, Saint-Etienne, France
| | - F Marcaillou
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | - A Hamdani
- Cancer Centre Oscar-Lambret, Lille, France
| | | | - Y Perier
- CH Avranches, CETD, Avranches, France
| | | | - C Gov
- HCL - Hôpital Neurologique, CETD, Lyon, France
| | - N Delage
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | | | - S Romettino
- Université Nice Côte-d'Azur, CHU Nice - Hôpital de Cimiez, Fédération Hospitalo-Universitaire INOVPAIN, CETD, Nice, France
| | - D Richard
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | - C Mallet
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | - L Bernard
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | - C Lambert
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France
| | - C Dubray
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France.,Analgesia Institute, Université Clermont Auvergne, Clermont-Ferrand, France
| | - C Duale
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France.,Analgesia Institute, Université Clermont Auvergne, Clermont-Ferrand, France
| | - A Eschalier
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de l'Innovation, CETD, CIC, CNRS, SIGMA Clermont, ICCF, Service de Pharmacie, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM - NEURO-DOL, Clermont-Ferrand, France.,Analgesia Institute, Université Clermont Auvergne, Clermont-Ferrand, France
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11
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Delage N, Morel V, Picard P, Marcaillou F, Pereira B, Pickering G. Effect of ketamine combined with magnesium sulfate in neuropathic pain patients (KETAPAIN): study protocol for a randomized controlled trial. Trials 2017; 18:517. [PMID: 29100524 PMCID: PMC5670712 DOI: 10.1186/s13063-017-2254-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Neuropathic pain is difficult to treat, and the efficacy of recommended drugs remains limited. N-methyl-d-aspartate receptors are implicated, and antagonists are a pharmacological option. Ketamine is widely used in French pain clinics, but without consensus or recommendations. Furthermore, the association of ketamine with magnesium has been poorly studied. The aim of the present study is to evaluate the benefit of ketamine with or without magnesium in refractory neuropathic pain. Methods/design A randomized, double-blind, crossover, placebo-controlled study will be performed in Clermont-Ferrand University Hospital, Clermont-Ferrand, France. The aim is to evaluate the effect of ketamine with or without magnesium in 22 patients with neuropathic pain. Intravenous ketamine/placebo, ketamine/magnesium sulfate, or placebo/placebo will be administered consecutively to each patient, in random order, once at 5-week intervals. The primary endpoint is the AUC of pain intensity assessed on a 0–10 Numeric Pain Rating Scale for a 5-week period. Data analysis will be performed on an intention-to-treat basis, and all statistical tests (except primary analysis) will be performed with an α risk of 5% (two-sided). Discussion Considering the poor efficacy of the drugs available for neuropathic pain, ketamine with or without magnesium sulfate may be a valuable therapeutic option that needs to be standardized. Trial registration EudraCT number–2015-000142-29. Registered on April 9, 2015; version 1.4 Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2254-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noémie Delage
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, F-63003, Clermont-Ferrand, France
| | - Véronique Morel
- Centre de Pharmacologie Clinique, Bâtiment 3C, CIC Inserm 1405, CHU Clermont-Ferrand, BP 69, F-63003, Clermont-Ferrand, Cedex 1, France.
| | - Pascale Picard
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, F-63003, Clermont-Ferrand, France
| | - Fabienne Marcaillou
- Centre d'Evaluation et de Traitement de la Douleur, CHU de Clermont-Ferrand, F-63003, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Délégation Recherche Clinique & Innovation - Villa annexe IFSI, 58 Rue Montalembert, F-63003, Clermont-Ferrand, Cedex, France
| | - Gisèle Pickering
- Centre de Pharmacologie Clinique, Bâtiment 3C, CIC Inserm 1405, CHU Clermont-Ferrand, BP 69, F-63003, Clermont-Ferrand, Cedex 1, France.,Inserm, U1107 Neuro-Dol, Pharmacologie Fondamentale et Clinique de la Douleur, Laboratoire de Pharmacologie, Faculté de Médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
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12
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Chenaf C, Kaboré JL, Delorme J, Eschalier A, Delage N, Authier N. Usage et mésusage des antalgiques opioïdes en France entre 2004 et 2015. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Chenaf C, Kabore JL, Delorme J, Pereira B, Mulliez A, Roche L, Eschalier A, Delage N, Authier N. Incidence of tramadol shopping behavior in a retrospective cohort of chronic non-cancer pain patients in France. Pharmacoepidemiol Drug Saf 2016; 25:1088-98. [PMID: 27363310 DOI: 10.1002/pds.4056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Opioid analgesic use in chronic non-cancer pain (CNCP) is increasingly prevalent, but the benefits and risks are inadequately understood. In France, tramadol is one of the most used prescription opioids, but studies on its misuse liability in CNCP are still lacking. The aim was to assess the incidence of tramadol shopping behavior in CNCP patients and to identify the associated risk factors. METHODS A retrospective cohort of CNCP patients aged 18 years and older treated by tramadol for at least six consecutive months between 2005 and 2013 from a sample of the French Health Insurance database was established. Doctor shopping was defined as at least 1 day of overlapping prescriptions written by two or more different prescribers and filled in at least three different pharmacies. RESULTS A total of 3505 CNCP patients were included with a majority of women (66.4%) and a mean age of 66.4 ± 14.7 years. The median tramadol treatment duration was 260 [interquartile range: 211-356] days. The 1-year incidence rate of tramadol shopping behavior was 1.0% [95%CI: 0.7-1.5]. On multivariate analysis, risk factors associated with tramadol shopping behavior were age (hazard ratio [HR] = 7.4 [95%CI: 2.8-19.7] for age <40, HR = 2.8 [95%CI: 1.0-7.7] for 40 ≤ age < 50, versus age ≥50), low-income status (HR = 8.5 [95%CI: 3.6-20.5]), and prior use of strong opioids (HR = 5.7 [95%CI: 1.9-17.0]). CONCLUSION Tramadol shopping behavior incidence appears low in CNCP patients but may represent a public health concern given the widespread use of tramadol. Education and best monitoring of high-risk patients are needed to reduce doctor shopping. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chouki Chenaf
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Jean-Luc Kabore
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Jessica Delorme
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
| | - Lucie Roche
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Alain Eschalier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Noémie Delage
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Nicolas Authier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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14
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Martin E, Morel V, Joly D, Villatte C, Delage N, Dubray C, Pereira B, Pickering G. Rationale and design of a randomized double-blind clinical trial in breast cancer: dextromethorphan in chemotherapy-induced peripheral neuropathy. Contemp Clin Trials 2015; 41:146-51. [PMID: 25636304 DOI: 10.1016/j.cct.2015.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anti-cancer chemotherapy often induces peripheral neuropathy and consequent cognitive and quality of life impairment. Guidelines recommend antiepileptics or antidepressants but their efficacy is limited.Dextromethorphan, a N-methyl-D-aspartate receptor antagonist, has shown its efficacy in painful diabetic neuropathy and in post-operative pain but has not been studied in chemotherapy-induced peripheral neuropathy. This clinical trial evaluates the effect of dextromethorphan on pain, cognition and quality of life in patients who suffer from neuropathic pain induced by chemotherapy for breast cancer. It also assesses the impact of dextromethorphan genetic polymorphism on analgesia. METHODS AND DESIGN This trial is a randomized, placebo-controlled, double-blind clinical study in two parallel groups (NCT02271893). It includes 40 breast cancer patients suffering from chemotherapy-induced peripheral neuropathy. They are randomly allocated to dextromethorphan (maximal dose 90 mg/day) or placebo for 4 weeks. The primary endpoint is pain intensity measured after 4 weeks of treatment on a (0-10) Numeric Pain Rating Scale. Secondary outcomes include assessment of neuropathic pain, cognitive function, anxiety/depression, sleep and quality of life. Data analysis is performed using mixed models and the tests are two-sided, with a type I error set at α=0.05. DISCUSSION Considering the poor efficacy of available drugs in chemotherapy-induced neuropathic pain, dextromethorphan may be a valuable therapeutic option. Pharmacogenetics may provide predictive factors of dextromethorphan response in patients suffering from breast cancer.
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Affiliation(s)
- Elodie Martin
- Clermont Université, Laboratoire de Pharmacologie, Faculté de médecine, F-63001 Clermont-Ferrand, France; Inserm, CIC 1405, UMR Neurodol 1107, F-63003 Clermont-Ferrand, France
| | - Véronique Morel
- Inserm, CIC 1405, UMR Neurodol 1107, F-63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France
| | - Dominique Joly
- Centre Jean Perrin, Centre de Lutte contre le Cancer, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Christine Villatte
- Centre Jean Perrin, Centre de Lutte contre le Cancer, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Noémie Delage
- CHU Clermont-Ferrand, Centre d'Evaluation et de Traitement de la Douleur, F-63003 Clermont-Ferrand, France
| | - Claude Dubray
- Clermont Université, Laboratoire de Pharmacologie, Faculté de médecine, F-63001 Clermont-Ferrand, France; Inserm, CIC 1405, UMR Neurodol 1107, F-63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation-Villa annexe IFSI, 58 Rue Montalembert, F-63003 Clermont-Ferrand cedex, France
| | - Gisèle Pickering
- Clermont Université, Laboratoire de Pharmacologie, Faculté de médecine, F-63001 Clermont-Ferrand, France; Inserm, CIC 1405, UMR Neurodol 1107, F-63003 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France.
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15
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Lefever G, Vieuille M, Delage N, harlingue A, de
Monteclerc J, Bompeix G. Characterization of Cell Wall Enzyme Activities, Pectin Composition, and Technological Criteria of Strawberry Cultivars (Fragaria
×ananassa
Duch). J Food Sci 2006. [DOI: 10.1111/j.1365-2621.2004.tb06320.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Delage N, Maaliki H, Beloeil H, Benhamou D, Mazoit JX. Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients: a study of interaction using sequential analysis and isobolographic analysis. Anesthesiology 2005; 102:1211-6. [PMID: 15915035 DOI: 10.1097/00000542-200506000-00022] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The analgesic efficacy of ketoprofen has been shown after moderate- and severe-pain surgery, and the analgesic efficacy of nefopam has been shown after moderate-pain surgery. The aim of this study was to define the median effective analgesic doses of each drug and to determine whether the interaction of nefopam and of ketoprofen is synergistic. METHODS Seventy-two patients scheduled to undergo moderately painful surgery were enrolled in one of three groups. The dose of nefopam and ketoprofen received by a particular patient was determined by the response of the previous patient of the same group, using an up-and-down technique. Initial doses were 18 and 40 mg, with dose adjustment intervals of 2 and 5 mg, in the nefopam and ketoprofen groups, respectively. The initial doses of nefopam and ketoprofen were 8 and 20 mg, respectively, in the nefopam-ketoprofen group, with the same dose adjustment intervals. Analgesic efficacy was defined as a decrease to less than 3 on a 0-10 numeric pain scale, 45 min after the beginning of drug infusion. RESULTS The median effective analgesic dose (median value and 95% confidence interval) of nefopam and ketoprofen were, respectively, 28 mg (17-39 mg) and 30 mg (14-46 mg). The median effective analgesic dose of the combination was 1.75 mg (0.9-2.3 mg) for nefopam and 4.3 mg (2.2-6.5 mg) for ketoprofen. CONCLUSION The isobolographic analysis demonstrated that the combination of the two drugs produces effective analgesia with an important synergistic interaction.
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Affiliation(s)
- Noémie Delage
- Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, Paris, France
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17
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Beloeil H, Delage N, Nègre I, Mazoit JX, Benhamou D. The Median Effective Dose of Nefopam and Morphine Administered Intravenously for Postoperative Pain After Minor Surgery: A Prospective Randomized Double-Blinded Isobolographic Study of Their Analgesic Action. Anesth Analg 2004; 98:395-400. [PMID: 14742377 DOI: 10.1213/01.ane.0000093780.67532.95] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED The aim of this study was to characterize the nature of analgesic interaction between nefopam and morphine administered i.v. for postoperative pain after minor surgery. To do so, we defined the median effective analgesic dose (ED(50)) for each drug and also the median ED(50) of their combination and compared them using the isobolographic method. Determination of median effective doses was performed by the up-and-down sequential drug administration in a two-stage study. First, in a prospective, randomized, double-blinded study, we enrolled 60 patients with mild to moderate pain after minor surgery; this was followed by an open study enrolling 30 patients. The end-point was a pain score less than 3 on a Numerical Pain Scale (0-10). Initial doses were 16 mg in group N, 5 mg in group M, and 7.5 mg of N combined with 2.5 mg of M in group N+M. The testing interval was 2 mg in group N, 1 mg in group M, and 1.5 mg of N combined with 0.5 mg of M in group N+M. ED(50) (95% confidence interval) was 5 mg (4-6 mg) for morphine, 18 mg (16-18 mg) for nefopam, and 4 mg (3.5-4.5 mg) with 12 mg (10.5-13.5 mg) for the combination of morphine and nefopam administered at a 3:1 dose ratio. Isobolographic analysis demonstrated a significant infra-additive interaction. The incidence of side effects did not differ significantly among morphine, nefopam, and their combination. These findings suggest that the combination of nefopam and morphine does not offer any advantage compared to each drug administered i.v. or alone after minor surgery. This study is the first to define the ED(50) of nefopam and morphine in postoperative patients. In conclusion, the addition of nefopam has a morphine-sparing effect, but the combination is infra-additive. IMPLICATIONS Pharmacologic interaction between nefopam and morphine shows infra-additivity but their combination may be clinically useful as morphine consumption is decreased in postoperative patients.
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MESH Headings
- Adult
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/adverse effects
- Analgesics, Non-Narcotic/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Hemodynamics/drug effects
- Humans
- Injections, Intravenous
- Male
- Middle Aged
- Morphine/administration & dosage
- Morphine/adverse effects
- Morphine/therapeutic use
- Nefopam/administration & dosage
- Nefopam/adverse effects
- Nefopam/therapeutic use
- Oxygen/blood
- Pain, Postoperative/drug therapy
- Prospective Studies
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Affiliation(s)
- Hélène Beloeil
- From the Department of Anesthesiology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris and the Anesthesia Laboratory UPRES EA 3540, Faculté de Médecine du Kremlin-Bicêtre Université de Paris-Sud, Le Kremlin-Bicêtre, France
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