RETROSPECTIVE ASSESSMENT OF FREQUENCY OF DOSING OF SUSTAINED RELEASE OPIATE PREPARATIONS IN CHRONIC PAIN PATIENTS

D. Adams, I. Gunyea, B. Bhakta, V. Movva, S. Ward, M. Jenson, M. Royal Pain Evaluation and Treatment Center, Tulsa, OK Departments of Internal Medicine and Anesthesiology/Pain Management, Oklahoma University College of Medicine (Tulsa and Oklahoma City) A retrospective chart review of 258 patients (67 on Duragesic®/fentanyl patches, 58 on MS Contin®/sustained release morphine, 57 on Kadian®/sustained release morphine, and 76 on Oxycontin®/sustained release oxycodone) was performed to evaluate the dosing frequency of various sustained release (SR) opiate preparations in patients with primarily chronic benign pain. Pain diagnoses included chronic degenerative conditions, arthridities, fibromyalgia, spine‐related conditions, abdominopelvic pain, complex regional pain syndromes, peripheral neuropathies, postherpetic neuralgia, radiculopathies, multiple sclerosis, and HIV neuropathy. There was no significant difference in the distribution of pain syndromes in each group or in the age and sex distribution. Duragesic® (25–500 mcg/h) was dosed q 72 h in 76.1% of patients (51/67) and q 48 h in 23.9% (16/67). Breakthrough (BT) medication (immediate release opiate formulation) was used in 58.2% (39/67). MS Contin® (15–800mg/d) was dosed q.d., b.i.d., t.i.d. or q.i.d. in 1.7 (1/58), 27.6 (16/58), 67.2 (39/58), and 3.4% (2/58) of patients, respectively. Dosing more frequently than b.i.d. was seen in 70.6% and additional BT medication was required in 56.9% (33/58). Kadian® (20–400mg/d) was dosed q.d., b.i.d., t.i.d. or q.i.d. in 61.4 (35/57), 33.3 (19/57), 3.5 (2/57), and 1.8% (1/57) of patients. Dosing more frequently than b.i.d. was seen only in 5.3% and BT medication was used in 42.1%. Oxycontin® (20mg‐320mg/d) was dosed b.i.d., t.i.d., or q.i.d. in 13.2 (10/76), 59.2 (45/76) or 27.6% (21/76) of patients. Dosing more frequently than b.i.d. was seen in 86.8% and BT medication was required in 56.6% (43/76). While there are many reasons for more frequent dosing of SR opiates, nearly every patient in this analysis reported perceived end‐of‐dose failure of analgesia as the reason for taking the medication more frequently. Kadian® appeared to maintain a less frequent dosing schedule than other SR opiate preparations.