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Effect of morphine versus tramadol on the immune response during the management of patients with chronic cancer pain
Background Although the inter-relationship between opioid analgesics and the immune system is not a simple one and may appear to vary depending on the opioid studied, the dose range of the opioid, the species in which studied, the immunological parameters measured, and the time course of the study,...
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Published in: | Ain-Shams journal of anesthesiology 2012-04, Vol.5 (2), p.250-255 |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Online Access: | Get full text |
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Summary: | Background
Although the inter-relationship between opioid analgesics and the immune system is
not a simple one and may appear to vary depending on the opioid studied, the dose
range of the opioid, the species in which studied, the immunological parameters
measured, and the time course of the study, increasing availability of data indicates
that opioid prescription and usage is lagging behind the available evidence of
significant opioid-induced immunosuppression in humans in a variety of disparate
situations.
Methods
Seventy patients complaining of cancer-related pain were randomly assigned to two
groups of 35 patients each. The tramadol group was treated with tramadol
hydrochloride 100–200 mg three times daily and followed up. The morphine group
was treated with controlled-release morphine sulfate tablets 30–60mg twice daily and
followed up. Systolic and diastolic arterial blood pressure, the mean heart rate, and the
mean respiratory rate were measured. Pain was assessed by verbal rating score and
the psychological state of the patients was assessed using the General Practitioner
Assessment of Cognition score. The daily activities of the patients were assessed by
the Lawton Instrumental Activities of Daily Living Scale and were reported before
starting therapy, 2, 4, and 6 weeks later. A laboratory study was performed by
measuring the serum level of interleukin (IL)-2, and interferon (IFN)-g before treatment,
and after 2 weeks and 6 weeks.
Results
There was a significant difference in the respiratory rate, verbal rating score, and
psychological state of the patients between the two groups. The concentration of IL-2
in the serum of patients in the morphine group decreased significantly compared with
that in the pretreatment phase (174.86 ±31.91, 124.44 ± 33.68, and
110.2± 22.46 pg/ml), respectively, whereas it increased in the tramadol group
compared with the pretreatment phase (177.14 ±20.83, 217.87 ± 24.01, and
219.58± 21.03 pg/ml); these changes were statistically significant. The concentration
of IFN-g in the serum of patients in the morphine group was found to decrease
significantly compared with that in the pretreatment phase (106.82± 4.52,
97.62 ± 10.17, and 95.89 ±9.59 pg/ml), respectively, whereas it increased significantly
in the tramadol group than that in the pretreatment phase (101.72 ±2.99 pg/ml,
125.51 ±8.71 pg/ml, and 139.93 ±6.35 pg/ml), respectively. Both IL-2 and IFN-g
showed no significant changes between both groups at baseline value, w |
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ISSN: | 1687-7934 2090-925X |