Hydromorphone levels and pain control in patients with severe chronic pain

Abstract

To better understand the use of narcotic analgesics, the hydromorphone concentration was measured in serum samples from 43 patients with chronic severe pain who were receiving this drug. At the time of blood sampling, pain intensity, mood, and cognitive performance were assessed. There was large individual variation in the dose-drug level relationship. Seven patients with bone or soft tissue pain and drug levels of greater than or equal to 4 ng/ml had good pain control, whereas 10 did not. None of 15 patients with levels less than 4 ng/ml had pain control, despite drug doses similar to those given patients with higher levels. Thus 60% of the patients without control of their pain had hydromorphone levels below the lowest level that produced pain control. No patient with pain from nerve infiltration or compression had good pain control, irrespective of the drug level or dose. Poor mood correlated with high pain intensity and low drug level. Impaired cognitive performance was not related to drug level. Knowing that there is a low concentration of narcotic in the blood of a patient with chronic severe pain who is receiving high drug doses and who shows lack of both efficacy and side effects may reassure health care professionals that further narcotic dosage escalation is appropriate.

Analgesic and Nonanalgesic Effects of Intravenous Hydromorphone ‐ Relation to Plasma Concentrations in Healthy Volunteers

“…The short duration of analgesia, measured as increase of PPT, corresponds to the findings of Coda et al (9) and the absent analgesic effects at the lower plasma concentrations agree with the results of Reidenberg et al (30). The larger variability of the effect of hydromorphone on PPT compared with the variability observed in the nonanalgesic effects may reflect the well known interindividual variability of analgesic effect of a standard dose of an opioid (6).…”

Hydromorphone: pharmacology and clinical applications in cancer patients

“…The usual indications for parenteral hydromorphone are difficulty in swallowing, nausea and vomiting, and altered consciousness [53,112,113]. Persons with chronic severe pain from bone or soft tissue tumor appear to require serum hydromorphone levels 1 4 ng/ ml to achieve pain control [88]. Hydromorphone can relieve continuous dull pain more effectively than sharp intermittent pain, but with sufficient amounts it is possible to relieve even the severe pain associated with renal or biliary colic [60].…”

“…The use of alternative m-receptor agonists, such as hydromorphone, has been hampered by the required 4-hourly dosing frequency. However, sustained-release hydromorphone is now available [15,41,48,88].…”

Cigarette Smoking, Coffee Drinking, and Ingestion of Charcoal-Broiled Beef as Potential Modifiers of Drug Therapy and Confounders of Clinical Trials

“…One reason is lack of readily available measurements of opioid analgesics. For example, a research study done with hospitalized patients receiving opioids for chronic severe pain found that 60% of patients with bone or soft tissue pain had plasma opioid concentrations lower than the lowest concentration in patients having pain relief (Reidenberg et al, 1988). There are large person-to-person differences in the metabolic inactivation of 5-fluorouracil (FU) by dihydropyrimidine dehydrogenese, and a study (Gamelin et al, 2008) using blood-level monitoring to adjust dosing regimens throughout drug therapy was shown to improve therapy.…”