Innovations In Clinical Neuroscience

Pain Management August 2016

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [August 2016] 13 average at 6.08 mmol/L. As indicated i n Fig. 2a, 11 out of 28 (39.29%), 2 out of 25 (8.00%), and 0 out of 25 (0.00%) patients in low, medium, and high cholesterol group did not respond to the initial doses of o pioids. Fisher's exact test suggested a significant difference between high and low cholesterol group (P value = 0.0045). In male patients, 71 patients (<4.10 mmol/L) were classified into low cholesterol group with an averaged cholesterol level at 3.43 mmol/L, 59 patients (>4.10 and <4.70 mmol/L) into medium group with an average at 4.38 mmol/L, while the other 74 patients (>4.70 mmol/L) into high group with an average at 5.38 mmol/L. As indicated in Fig. 2b, 31 out of 71 (43.66%), 19 out of 59 (32.20%), and 8 out of 74 (10.81%) patients in low, medium, and high cholesterol group did not respond to the initial doses of opioids. Fisher's exact test suggested a significant difference between high and low cholesterol group (P value = 0.0009). Since three kinds of opioids were used, each cholesterol group was further divided into three sub- groups according to which type of opioids they used. As summarized in Table 1, patients with low cholesterol level have higher probability to require higher opioid doses than those with high cholesterol levels. Significant differences were identified between high and low cholesterol group in male patients received fentanyl (P value = 0.0049, **) or oxycodone (P value = 0.0307, *) (Table 1). In addition, no significant difference was identified among different opioid sub-groups a s determined by Fisher's exact test. Therefore, considering the f act that pain levels of patients were controlled at similar levels, from level 5 to 8, the observations suggested that patients with low cholesterol levels have higher possible to not respond to initial dose of opioids. Cholesterol level correlates with final opioid dose. Since no significant difference was identified between different opioids as determined by Fisher's exact test (Table 1), the initial doses of these three opioids should be equivalent or close to equivalent to each other. Basing on the NCCN guidelines and previous reports on equivalent doses (Table 2) [6, 24, 25, 26, 27], every 30 mg/day morphine sulfate in controlled-release tablets or 25 μg/h fentanyl in transdermal patch was calculated as 10 mg/day oxycodone hydrochloride in controlled-release tablet. The converted doses were plotted against the serum total cholesterol levels. As indicated in Fig. 2c-d, significant correlation between final opioid dose and serum total cholesterol level was found in both female and male patients. In female patients, Pearson's rank correlation coefficient was −0.5214 (P < 0.0001, Gaussian approximation, n = 78). In male patients, Pearson's rank correlation coefficient was −0.3523 (P < 0.0001, Gaussian approximation, n = 204). In addition, no correlation was observed between final opioid dose and age (Fig. 2e-f). In female patients, Pearson's rank correlation coefficient was −0.1907 (P = 0.0945, Gaussian approximation, n = 78). In male patients, Pearson's rank correlation coefficient was 0.1293 (P-0.0652, Gaussian approximation, n = 204). However, the correlation between cholesterol level and opioid dose might be attributed to the influences of opioids on cholesterol levels. The current studies were only focused on the initial doses of opioids, which were determined within the first week after opioid administration. Because of such a short time and

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