Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory ('triple-agent') therapy for episodes of acute on chronic pain.
OBJECTIVE
This prospective audit was undertaken in order to document the analgesic response and adverse effects of concurrent short-term ('burst') triple-agent analgesic (ketamine, an opioid and an anti-inflammatory agent--either steroidal or non-steroidal) administration, for episodes of acute on chronic pain. The clinical hypothesis in this study is that better pain control may be obtained by simultaneous multiple target receptor blockade.


METHODS
The response of 18 patients is reported. The pain and analgesic requirement data for the 24 h before starting triple-agent therapy were compared with the last 24 h on the triple-agent therapy. Patients were then classified as responders or non-responders.


RESULTS
According to stringent clinical criteria, 12 out of the 18 patients were classified as responders. The response rate was highest for somatic pain (7/9) and appeared to decrease with duration of prior uncontrolled pain. Only four out of the 18 patients reported adverse effects and all of these were minor.


CONCLUSIONS
The results suggest that this 'burst' triple-agent approach is safe and effective in an inpatient palliative care population during episodes of poorly controlled acute on chronic pain, and warrants further investigation to ascertain whether it gives superior results compared to the 'gold-standard' WHO ladder approach.
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Department of Medicine, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and Medicine Program, Southern Health, McCulloch House, Monash Medical Centre, Melbourne, Victoria, Australia.
Tullio
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Jackson
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Goodchild
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Ashby
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D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002908:Chronic Disease; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007649:Ketamine / Q000008:administration & dosage*; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy*; D011446:Prospective Studies
D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007649:Ketamine; D003907:Dexamethasone; D010098:Oxycodone; D004091:Hydromorphone; D020910:Ketorolac