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Clinical Control of Tramadol Therapeutical Use in Management of Cancer Pain (Pengamatan Klinis Pemakaian Tramadol untuk Mengatasi Nyeri Kanker)

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Cancer has become a major problem in health situation nowadays. As high as 70 percent to 90 percent of cancer patients, especially ones already in advanced state, have pain as their major symptom. Pain in cancer patients is caused by cancer invasion and metastasis, side effect of cancer therapy, or by other aethiologies. The use of non-opioid, opioid analgesics and adjuvants in cancer pain management is based on WHO's protocol, which administration of the drug is by the ladder and by the clock. Forty cancer patients, 25 males and 15 females with pain as their major symptom were treated. Prior to tramadol administration, the pain intensity was first measured using Visual Analogue Scale (VAS). An initial dose of 50 milligram tramadol was given intravenously, continued with interval of 6-8 hours. Treatment was evaluated everyday until the effective dose, which gave VAS value less than 40, was reached. Tramadol could be given in combination with adjuvants, and/or non-opioid analgesics, if needed. However, when the dose of tramadol has reached 600 milligram per day, and patient still felt pain, then, in accordance with WHO's analgesic stepladder, the patient was swiched to be given strong opioid. Sixteen (40 percent) patients were given tramadol, while 24 (60 percent) intravenously, intermittent or continously. To reach VAS value below 40, 10 percent patients needed tramadol 200 milligram per day, 52.5 percent needed 400 milligram per day, and 27.5 percent needed 600 milligram per day, while the other 10 percent were switched to strong opioid. Fifteen percent patients were given tramadol combined with metamizole, 5 percent with acetosal, 10 percent with amitriptylline, 57.5 percent with estazolam and 7.5 percent with bromazepam. Side effects were observed in 3 (7.5 percent) patients : 1 with nausea, 1 nausea to vomit which led to discontinuation of medication, while an other one suffered constipation. No severe side effects, such as respiratory depression or addiction were found. This clinical observation found out that dosage of tramadol to relieve cancer pain ranging from 150 milligram to 600 milligram a day. Tramadol is proven effective and safe for cancer pain management, and can be combined with non-opioid analgesics and other adjuvants as second-step analgesic in WHO's protocol. Study on pain intensity and type of pain crucial to achieve the goals of the therapy.

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Medika,21(12)1995:935-938

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: ., 1995

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neoplasms
tramadol

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