[Effectiveness of a pharmaceutical care unit for the control of severe chronic pain]

The effectiveness of a pharmaceutical care unit was assessed within a staged program for non-malignant severe chronic pain control in a multidisciplinary pain management unit at Consorcio Hospital General Universitario, Valencia, Spain.

One hundred and fifty patients with clinical indication for a major opioid were included in WHO's third analgesic rung by our medical team following careful triage. The pharmaceutical care unit, or phase II, monitored dosage titration for pain stabilization with absence of side effects, as well as the onset of subsequent chronic therapy.

Upon program completion 75% of patients had their pain under control, having required 22.7 days on average for opiate dose titration. Mean daily dose was 22.3 mg, and constipation was prophylactically managed from the start. Fifty-nine percent of patients received subsequent chronic therapy with fentanyl transdermal patches at 25 microg/h; 10% followed suit with oral morphine solution, and 6% with controlled-release morphine. Twenty-five percent of the remaining patients had relevant events during the therapy titration stage, which led to therapy discontinuation and discharge because of lack of therapeutic effectiveness. After 24 months 70% of patients were still on initial doses.

The effectiveness of our unit was demonstrated by the achievement of the program objectives.