The impact of tramadol and dihydrocodeine treatment on quality of life of patients with cancer pain
Résumé
Background: Tramadol and dihydrocodeine (DHC) are analgesics of step 2 WHO analgesic ladder (opioids for mild to moderate pain, weak opioids) frequently used in the treatment of cancer pain of moderate intensity. The aim of the study was to assess the impact of tramadol and DHC treatment on quality of life (QL) and performance status (PS) of patients with cancer pain. Patients and methods: Randomized, cross-over, clinical study of 40 opioid-naive patients with nociceptive cancer pain who received tramadol or DHC controlled release tablets for 7 days, then drugs switched and administered for another 7 days. Pain was assessed by VAS (visual anlogue scale), QL by EORTC QLQ C 30; PS by ECOG and Karnofsky. Results: From 40 patients recruited thirty completed the study. DHC treatment provided better analgesia (VAS). In QL functional scales better emotional functioning in tramadol group; better global QL and cognitive functioning in DHC group were observed. In symptom scales less fatigue, pain and sleep disturbances, less nausea and vomiting and better appetite in DHC group were noted. In tramadol group less constipation and less financial problems were observed. No differences in dyspnoea and diarrhoea were noted. ECOG and Karnofsky PS were low and did not differ between tramadol and DHC groups. Conclusions: DHC treatment was associated with better global QL, cognitive functioning, analgesia and appetite, less fatigue, sleep disturbances, nausea and vomiting. Tramadol therapy was connected with better emotional functioning, less constipation and financial problems. PS deteriorated in both tramadol and DHC groups. Key words: cancer pain, dihydrocodeine, performance status, quality of life, tramadol
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