gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Opiod Therapy of Severe Pain in Multiple Myeloma

Meeting Abstract

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  • corresponding author presenting/speaker Heinrich Lannert - Medizinische Klinik der Universität Heidelberg, Abteilung Hämatologie, Onkologie und Rheumatologie, Deutschland

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO545

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Lannert.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Aim: Multiple myeloma is a clonal B-cell disease of slowly proliferating plasma cells, accompanied by monoclonal protein production und lytic bone lesions. More than 30% of the new diagnosed patients have a pathological fracture. The aim of the present study was the documentation and evaluation of analgesic therapy in patients with multiple myeloma in stage IIIA/B. Method: As part of a chemotherapy optimisation study, the patients’ pain therapy was documented. The severity of pain was recorded with a standardised pain questionnaire using a visual analogue scale (VAS) from 0 (neither pain nor impairment) to 10 (severest imaginable pain, impairment). Follow-up examinations took place after 3 days, 1 month and 3 months. All patients were treated with bisphosponates i.v. every 4 weeks.

Results: 123 patients (60.9%) of 202 new diagnosed patients with multiple myeloma stage III, were treated with analgesics because of severe pain. The average duration of follow-up documentation was 11.6 months. 100 patients received analgesics orally or transdermally (fentanyl or buprenorphine), and 32 of these patients received oral controlled-release hydromorphone at day 3 of this study.

Additionally, 5 patients were treated with kypho/-vertebroplasty or prosthesis and 54 patients were radiated. 4 patients being treated with a transdermal system (n=19) and another 8 patients who received a different analgesic (n=49) were changed to hydromorphone during the observation period. Thus, at the end of the study, 44 patients were receiving controlled-release hydromorphone in a mean dosage of 20 mg twice daily. Starting with equal pain severity (VAS=8) it was reduced to 0.6 on the 3rd day of treatment with hydromorphone, while VAS dropped to only 2.2 during transdermal therapy. After 3 months, the average pain severity with hydromorphone reached 0.4 compared to 2.0 with transdermal analgesic therapy. In this observation phase, typical opioid side effects (obstipation, nausea, emesis) requiring treatment had occurred with 2 patients (4.5 %, only mild obstipation) of the hydromorphone group (n = 44) and with 6 patients (40%) of the transdermal group (n = 15).

Conclusion: Controlled-release hydromorphone has demonstrated that it successfully relieves severe pain in patients with multiple myeloma under routine clinical conditions. In comparison with transdermal systems, controlled-release hydromorphone proved to be significantly more efficient and tolerable with a short adjustment period.