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Hot Topics in Pain Management [August 2016] 15 fixed low dose of opioids. Thus p atients who have lower BMIs or lighter body weights received higher dose of opioids initially as calculated as mg/kg. In addition, according to our observations, patients with lower c holesterol levels normally have lower BMIs and actually require higher dose of opioids. Therefore patients with lower cholesterol levels already received lower dose of opioids under current paradigm. Such fact of truth decreased the Pearson's rank correlation coefficient of observed correlation at least partially, but also support our conclusion, low cholesterol patients require more opioids, since it is already applied in clinical practice though not purposely. Basing on the NCCN guidelines and previous reports [6, 24, 25, 26, 27], every 30 mg/day morphine sulfate in controlled-release tablets should be calculated as 10 ~ 20 mg/day oxycodone hydrochloride in controlled-release tablet. In order to make the initial doses of different opioids at similar levels, 30 mg/day morphine sulfate was calculated as 10 mg/day oxycodone hydrochloride. According the information provided in the instruction of current fentanyl patch, 25 μg/h fentanyl in transdermal patch could be calculated as 20 ~ 30 mg/day morphine. Thus we further calculated 25 μg/h fentanyl as 10 mg/day oxycodone hydrochloride in controlled-release tablet. High serum cholesterol level has been suggested to be a high risk factor for cardiovascular diseases [40]. The cholesterol lowering drugs like statins have been used widely to prevents cardiovascular diseases in elder people [41, 42]. In addition, weight loss during the late phase of cancer may also lead to the decrease in cholesterol level. Thus cholesterol level of cancer patients may be lower than healthy controls [43, 44, 45], and should require higher dose of opioids as pain killer. Conclusions. 1) Low cholesterol lung cancer patients are more likely to not respond to initial doses of opioids; 2) There is correlation between opioid usages and cholesterol levels; and 3) Similar o bservations were obtained with three different types of opioids. METHODS Clinical records retrieval. All c urrent studies were based on the patients' clinical records. The investigation abide by the Ethical Principles for Medical Research Involving Human Subjects outlined in the Declaration of Helsinki and was approved by the Institutional Re Board of Nanfang Hospital, Guangzhou, China. Written informed consents to share clinical records for medical and non-profit research were signed by corresponding patients or their representatives during treatment. Clinical records selection. Clinical records of about 9,000 lung cancer patients in current database of Department of Oncology, Nanfang Hospital, Guangzhou, China were used. Any record missing informed consents was removed from our selection. Personal information and information un-related to our studies were not included during data collection, transfer and analysis to protect privacy. In current database, lung cancer patients with pain level over level 5 (assessed with NCCN guideline) were administrated with a relative low dose of opioids initially (initial dose), which was normally 10 mg/day oxycodone hydrochloride in controlled-release tablets, 30 mg/day morphine sulfate in controlled-release tablets, or 25 Wg/h fentanyl in transdermal patch. Patients were re-visit on the next day or earlier if necessary to assess pain management. Only when the pain level was unchanged or increased, the doses of opioids were increased by additional one fold of initial dose. If a dose of opioid was able to control pain for two constitutive days, that dose was considered as final dose. Serum total cholesterol levels were required to be measured within one week from when final dose was determined. Firstly, since opioid administration was recorded for all the patients, patients have serum total cholesterol l evels measured within one week from when "final doses" of opioids were determined (normally during the first several days of opioid administration) were selected. S econdly, to reduce influences from the development of opioid tolerance, opioid-naïve patients were selected. Opioid-naïve patients were patients who have not received more than 60 mg/day morphine or other opioids at equivalent doses for three days in last one year. Patients who did not receive their initial dose at doses mentioned above were excluded in our analysis Thirdly, to avoid potential drug-drug interaction, we selected patients who required opioid as pain-killer (pain level over level 5), but had not received surgery, radiation treatment, chemotherapy, or additional treatments for cancer-related syndrome or other diseases. In addition, patients who were using cholesterol lowering drug like statins were also removed from our analysis [6]. Finally, to control the pain levels of the patients, we further selected the patients whose pain intensities were rated around level 5 to 8 with NCCN guideline. Pain assessment. Pain level information used in current studies was obtained from patients' medical records. Normally, pain levels of patients were assessed once per day or when necessary following guideline provided by NCCN. Briefly, patients were asked about "current" pain, as well as "worst" pain, "usual" pain, and "least" pain in the past 24 h. Pain assessment was also helped by using "the Faces Pain Scale" as previously reported [46]. Statistical analysis. Necessary data were collected from clinical records and listed in Additional file 1: Table S1 because the large quantity of the information. Statistical analyses were performed with GraphPad Prism 5.0. Pearson test was used to determine the correlation between two parameters and Pearson's rank correlation coefficient and P values were provided. Linear regression was