UI - 000092

AU - Reidenberg MM

AU - Goodman H

AU - Erle H

AU - Gray G

AU - Lorenzo B

AU - Leipzig RM

AU - Meyer BR

AU - Drayer DE

TI - Hydromorphone levels and pain control in patients with severe chronic pain [published erratum

appears in Clin Pharmacol Ther 1991 Mar;49(3):313]

AB - 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

SO - Clinical Pharmacology & Therapeutics 1988;44:376-382