Continuous subcutaneous octreotide in gastrointestinal cancer patients: pain control and beta-endorphin levels.
BACKGROUND
Somatostatin is a naturally occurring hormone widely identified in a number of human tissues, with a broad spectrum of physiological actions. Octreotide is a synthetic analogue of somatostatin, which seems to be promising in clinical use.


OBJECTIVE
a. to evaluate the efficacy of octreotide in pain control of patients with advanced gastrointestinal cancer, as well as octreotide's outcome in the hepatic function; b. to investigate the relationship between pain intensity and beta-endorphin blood levels in the patients.


METHODS
The study group consisted of 25 patients (age range: 48-89 years, 14 males, 11 females) with far advanced gastrointestinal cancer.


METHODS
All the patients were under s.c. morphine administration using a continuous infusion pump. When pain intensity increased, 0.6 mg/day of octreotide was added to the therapeutic regimen in the same syringe of the continuous infusion pump. Pain intensity and beta-endorphin blood levels were measured five times: Once before octreotide administration and the other four 12, 24, 48 hours and 7 days after. A complete blood count and a biochemical screening profile were taken before the administration of octreotide as well as on the 7th and the 14th day.


RESULTS
24 out of 25 cases showed a reduction in pain intensity (pretreatment x = 5.3, post-treatment x = 0.6). beta-endorphin blood levels increased significantly during the study (an increase of 184.78% was observed on the 7th treatment day). In one patient pain control was achieved by increasing morphine dosage. Statistically significant changes were observed in hepatic function indices (p < 0.02). Significant side-effects were not observed.


CONCLUSIONS
Octreotide can be used as an adjuvant analgesic in the management of gastrointestinal cancer pain which is managed by continuous s.c. administration. Although fuither research needs to be done, octreotide's administration seemed to improve hepatic function of these patients, therefore, it could potentially have a positive effect in the patient's quality of life.
Pain Relief and Palliative Care Unit, Areteion Hospital, University of Athens, Vas. Sofias 76, 11528, Athens, Greece.
S
S
Befon
K
K
Mystakidou
M
M
Lyra
N
N
Tubanakis
L
L
Vlahos
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005770:Gastrointestinal Neoplasms / Q000503:physiopathology*; D006801:Humans; D007263:Infusions, Parenteral; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control; D010147:Pain Measurement; D013997:Time Factors; D001615:beta-Endorphin / Q000097:blood*
D000700:Analgesics; D015415:Biomarkers; D005765:Gastrointestinal Agents; D001615:beta-Endorphin; D015282:Octreotide