Continuous subcutaneous administration of high-dose salmon calcitonin in bone metastasis: Pain control and beta-endorphin plasma levels

This prospective nonrandomized trial was performed to evaluate the efficacy of salmon calcitonin (sCT) in controlling pain related to bone metastasis in cancer patients and the relation of sCT's analgesic efficacy with beta-e ndorphin blood levels. The study group consisted of 22 cancer patients with bone metastases (male 13 and female 9, age range 38-77 years). Pain contro l was first achieved by continuous subcutaneous (sc) morphine administratio n. The next increase in pain was managed with continuous sc administration of 400 IU/day sCT Beta-endorphin blood levels were measured before and duri ng sCT administration. The first measurement was taken before sCT administr ation; subsequent measurement occurred at 12, 24 and 48 hours and 7 days af ter the commencement of treatment. Pain scores were monitored by a visual a nalogue scale A complete blood count and a biochemical screening profile we re taken before the administration of calcitonin and also on the seventh an d the fifteenth day of the administration. The results showed a satisfactor y analgesic effect. The mean pain score before the calcitonin administratio n was 4.43 and the score on the seventh day was 1.17 The gradual reduction of pain score wets associated with an increase in beta-endorphin blood leve ls (increase to 147.2% of baseline on the seventh treatment day). In three cases, no satisfactory analgesic effect was obtained and pain control was a chieved by increasing the continuous sc morphine dosage. No significant sid e effects were observed. These data suggest that sCT in high doses may be a useful adjuvant analgesic when combined with low doses of morphine in cont inuous sc administration for the management of metastatic bone pain. J Pain Symptom Manage 1999;18:323-330. (C) U.S. Cancer Pain Relief Committee, 199 9.