Cuidados paliativos y medicina

Abstracto

Plasma Concentration of Oxycodone and Pain during Hemodialysis in a Patient with Cancer

Satoshi Murakami, Mizuki Herai, Satoshi Suzuki, Takayuki Fujii, Hiroaki Tanaka, Mizuki Shinozaki, Hideya Kokubun, Toru Akagi, Yasuhito Uezono, Yuko Murakami-Ando, Seiji Shiraishi, Motohiro Matoba

Pain is one of the most common problems in palliative medicine, and opioid therapy should be used adequately. Clinically, many cancer patients with severe renal dysfunction receive opioids for pain control. However, the pharmacokinetics of opioids during hemodialysis are not completely understood. We investigated the time course of the plasma concentration of oxycodone and pain during hemodialysis in a 55-year-old man using oxycodone for cancer pain. The patient’s plasma concentration of oxycodone decreased during hemodialysis, and increased after it ended. Conversely, his pain increased after the beginning of hemodialysis, and improved after it was finished. Additionally, our results did not show a relationship between the plasma concentration of oxycodone and his pain. Breakthrough pain occurred several times during hemodialysis irrespective of the plasma concentration of oxycodone. The decrease in plasma oxycodone during hemodialysis appeared to be caused by the removal of oxycodone by hemodialysis, and the later increase after hemodialysis appeared to be related to the redistribution of oxycodone. On the other hand, breakthrough pain during hemodialysis may be caused by hemodialysis itself, rather than due to the decrease of the plasma concentration of oxycodone, given that no relationship between the plasma concentration of oxycodone and pain could be identified. When building a strategy of pain management during hemodialysis, both the possibilities of a decrease in the plasma concentration of oxycodone by hemodialysis and the increase of pain by hemodialysis itself should be considered.