Maastricht PhD candidate Johan Haumann has won the Best European Paper of the Year Award 2019 from the European Association for Palliative Care with a study into painkillers for head / neck cancer patients. Together with other Maastricht researchers in the field of pain medicine and palliative medicine, Haumann investigated which patients with pain benefit more from treatment with morphine-like painkillers (opioids) and which patients have less chance of good pain relief with opioids. The article was published in the magazine Journal of Palliative Medicine.
Cancer pain is difficult to treat and often requires opioids. To date, it has never been properly investigated how the effectiveness of these opioids for pain reduction can be predicted. Haumann wanted to use his research to come up with a model to predict which patient categories experience pain reduction after a week of using the opioids fentanyl or methadone.
Types of pain
Haumann involved 134 patients in his study: 52 patients with neuropathic pain, that is pain due to nerve damage, and 82 with so-called nociceptive pain. This is ‘normal’ pain in the skin, a muscle, bone, joint or organ as a result of a wound, bruise or inflammation. Half of both patient groups received fentanyl, the other half methadone. Subsequently, the relationship between certain patient characteristics, such as the type of pain (neuropathic or nociceptive), the age of the patient, the duration of the pain and the method of treatment of the cancer was examined.
Greater effect of methadone
The study found that opioids worked better in patients with neuropathic pain, worked better in young patients than in older patients, and worked better in patients who had long-term pain. Pain relief was more likely with methadone than with fentanyl. No difference was found when it comes to the type of treatment that patients received: surgery, treatment with chemotherapy or radiotherapy (radiation) or a combination of those therapies, it made no difference to the effect of the chosen pain relief.
Model
According to Haumann, the research is a first step in developing a model for more patients, not just for patients with head / neck cancer. “Ultimately, we hope to expand it even further and develop a predictive model that is suitable for all palliative patients.” However, it is not that far yet, more research will be needed for that. This future research will be a collaboration between Maastricht UMC + and the OLVG. Haumann obtained his PhD at the beginning of this year for his research in Maastricht, and now works at the OLVG in Amsterdam as an anesthetist-pain specialist.
Source: Maastricht UMC +
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