Does tramadol cause constipation. How common is constipation with tramadol use. What are the other common side effects of tramadol. How can opioid-induced constipation be managed.

The Link Between Tramadol and Constipation

Tramadol, an opioid medication used to treat moderate to severe pain, is known to cause constipation in many patients. This side effect is not unique to tramadol but is common among opioid medications. Constipation occurs due to the way opioids interact with receptors in the digestive system, slowing down bowel movements.

How prevalent is constipation among tramadol users? Studies have shown that constipation affects between 9% to 46% of patients taking tramadol. This wide range suggests that individual responses to the medication can vary significantly. In some cases, constipation may be severe enough to warrant discontinuation of the treatment.

Risk Factors for Tramadol-Induced Constipation

Certain factors can increase the likelihood or severity of constipation when taking tramadol:

• Age: Older patients, particularly those over 75, are at higher risk
• Concurrent medications: Other drugs with constipating effects can exacerbate the problem
• Dose and duration: Higher doses and longer-term use may increase the risk
• Individual physiology: Some people are naturally more prone to constipation

Other Common Side Effects of Tramadol

While constipation is a significant concern, tramadol can cause various other side effects. Understanding these potential effects can help patients and healthcare providers manage treatment more effectively.

Gastrointestinal Side Effects

Tramadol commonly affects the digestive system. Apart from constipation, users may experience:

• Nausea (16% to 40% of patients)
• Vomiting (5% to 17% of patients)
• Dry mouth (5% to 13% of patients)
• Heartburn (1% to 13% of patients)

Central Nervous System Effects

Tramadol can also impact the central nervous system, leading to effects such as:

• Dizziness
• Fatigue or sleepiness
• Headaches
• Anxiety
• Physical tremors (in rare cases)
• Hallucinations (very rare, especially when taken as prescribed)

Managing Tramadol-Induced Constipation

Given the high prevalence of constipation among tramadol users, it’s crucial to address this side effect promptly. How can patients manage opioid-induced constipation?

1. Increase fluid intake: Drinking more water can help soften stools
2. Dietary changes: Consuming more fiber-rich foods may improve bowel movements
3. Regular exercise: Physical activity can stimulate bowel function
4. Over-the-counter laxatives: Under medical guidance, these can provide relief
5. Prescription medications: Specific drugs designed to treat opioid-induced constipation may be prescribed

It’s essential to consult with a healthcare provider before starting any new treatment for constipation, especially when taking opioid medications like tramadol.

The Importance of Monitoring and Reporting Side Effects

Why is it crucial to keep track of side effects when taking tramadol? Monitoring and reporting side effects helps healthcare providers adjust treatment plans and ensure patient safety. Severe or persistent side effects may necessitate changes in medication or dosage.

When should patients contact their healthcare provider about tramadol side effects? It’s advisable to seek medical attention if:

• Constipation becomes severe or persistent
• Nausea or vomiting interferes with daily activities
• Dizziness or fatigue becomes excessive
• Any unusual or severe symptoms occur

Tramadol Use in Special Populations

How does tramadol affect different patient groups? The impact of tramadol can vary depending on factors such as age, overall health, and concurrent medications.

Elderly Patients

Older adults may be more susceptible to tramadol’s side effects, including constipation. In studies, up to 10% of patients over 75 years old discontinued treatment due to constipation. Healthcare providers often monitor elderly patients more closely and may adjust dosages to minimize side effects.

Patients with Pre-existing Conditions

Individuals with certain health conditions may need special consideration when taking tramadol:

• Liver or kidney disease: May affect drug metabolism and excretion
• History of gastrointestinal issues: Could exacerbate digestive side effects
• Respiratory conditions: Opioids can suppress breathing, requiring careful monitoring

Alternatives to Tramadol for Pain Management

For patients experiencing significant side effects from tramadol, what are the alternative pain management options? Healthcare providers may consider:

• Non-opioid pain medications (e.g., NSAIDs, acetaminophen)
• Other classes of opioids that may have different side effect profiles
• Non-pharmacological approaches (e.g., physical therapy, acupuncture)
• Combination therapies to reduce reliance on a single medication

The choice of alternative treatment depends on the individual’s specific pain condition, overall health, and response to different therapies.

The Risk of Tramadol Dependence and Addiction

While tramadol is effective for pain management, it carries a risk of dependence and addiction. How can patients and healthcare providers mitigate these risks?

1. Adherence to prescribed dosages and schedules
2. Regular check-ins with healthcare providers to assess ongoing need and effectiveness
3. Monitoring for signs of tolerance or drug-seeking behavior
4. Considering alternative pain management strategies when appropriate
5. Gradual tapering of the medication when discontinuing use

Understanding the potential for dependence is crucial for both patients and healthcare providers to ensure safe and effective use of tramadol.

Long-term Effects of Tramadol Use

What are the potential consequences of long-term tramadol use? While tramadol can be an effective pain management tool, prolonged use may lead to:

• Increased tolerance, requiring higher doses for the same pain relief
• Physical dependence, leading to withdrawal symptoms if discontinued abruptly
• Chronic constipation and other persistent gastrointestinal issues
• Potential hormonal imbalances
• Increased risk of falls and fractures, especially in older adults

Healthcare providers typically weigh these potential long-term effects against the benefits of pain management when prescribing tramadol for extended periods.

Monitoring Long-term Use

How can the risks associated with long-term tramadol use be minimized? Strategies include:

1. Regular follow-up appointments to assess ongoing need and effectiveness
2. Periodic evaluations of pain levels and functional improvements
3. Routine screening for side effects and complications
4. Consideration of drug holidays or rotation to other pain management strategies
5. Patient education on recognizing signs of tolerance or dependence

Interactions Between Tramadol and Other Medications

Tramadol can interact with various other medications, potentially altering its effectiveness or increasing the risk of side effects. What are some important drug interactions to be aware of?

• Selective Serotonin Reuptake Inhibitors (SSRIs): Can increase the risk of serotonin syndrome
• Monoamine Oxidase Inhibitors (MAOIs): Can lead to dangerous interactions
• Other opioids: May increase the risk of respiratory depression
• Benzodiazepines: Can enhance sedative effects
• Carbamazepine: May reduce tramadol’s effectiveness

Patients should always inform their healthcare providers about all medications they are taking, including over-the-counter drugs and supplements, to avoid potential interactions.

Managing Drug Interactions

How can healthcare providers manage potential drug interactions with tramadol? Strategies may include:

1. Adjusting doses of tramadol or interacting medications
2. Monitoring patients more closely for side effects
3. Choosing alternative pain management options when interactions are unavoidable
4. Educating patients about potential interaction symptoms to watch for
5. Regular medication reviews to assess for new potential interactions

Patient Education and Informed Decision-Making

Empowering patients with knowledge about tramadol is crucial for safe and effective use. What key information should patients receive?

• Proper dosing and administration instructions
• Potential side effects and how to manage them
• Signs of adverse reactions or overdose
• The importance of not sharing medication
• Safe storage and disposal practices
• The need for regular follow-ups with healthcare providers

Informed patients are better equipped to use tramadol safely and report any concerns promptly to their healthcare providers.

Shared Decision-Making in Pain Management

How can patients and healthcare providers work together to make informed decisions about tramadol use? The process may involve:

1. Discussing the patient’s pain history and treatment goals
2. Reviewing potential benefits and risks of tramadol
3. Exploring alternative pain management strategies
4. Considering the patient’s lifestyle and preferences
5. Developing a personalized treatment plan with regular reassessments

This collaborative approach ensures that pain management decisions align with the patient’s needs and values while prioritizing safety and effectiveness.

Future Developments in Pain Management

As medical research progresses, what future developments might impact the use of tramadol and management of its side effects? Areas of ongoing research include:

• Development of opioids with reduced side effect profiles
• Advanced formulations to minimize constipation and other gastrointestinal effects
• Novel non-opioid pain management therapies
• Personalized medicine approaches to predict individual responses to pain medications
• Improved strategies for preventing and treating opioid-induced constipation

These advancements may offer new options for patients who struggle with tramadol side effects or seek alternatives for pain management.

The Role of Genetics in Pain Management

How might genetic factors influence an individual’s response to tramadol? Emerging research suggests that genetic variations can affect:

1. Metabolism of tramadol, impacting its effectiveness and side effect profile
2. Susceptibility to opioid-induced constipation
3. Risk of developing dependence or addiction
4. Overall pain sensitivity and response to various pain management strategies

As our understanding of pharmacogenomics grows, it may become possible to tailor pain management approaches more precisely to individual patients, potentially reducing side effects and improving outcomes.

Does tramadol cause constipation?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 7, 2022.

Yes, tramadol can cause constipation and is one of the most common side effects with this drug. In studies, constipation was reported in 9% to 46% of patients. In some cases it may be severe. Call your healthcare provider if you have any tramadol symptoms and they are severe.

• Constipation is a well-known and expected side effect of opioid use. It should be addressed quickly to prevent further complications.
• Use extra caution in older patients and monitor more closely. In studies, constipation resulted in discontinuation of treatment in 10% of those over 75 years of age.
• The use of other drug therapies that lead to constipation, such as anticholinergic drugs, can worsen the constipating effect of tramadol. If you are not sure if you are taking other medicines that may worsen constipation, ask your doctor or pharmacist.

To learn more: Treatment of Opioid-Induced Constipation: The Hard Facts

Tramadol (Ultram) is commonly associated with other stomach (gastrointestinal) side effects such as:

• nausea (16% to 40%)
• vomiting (5% to 17%)
• dry mouth (5% to 13%)
• heartburn (1% to 13%)

Tramadol side effects (in more detail)

Bottom Line

• Tramadol can cause constipation in 9% to 46% of patients. Stomach side effects in general are common with tramadol.
• Constipation is a well-known side effect of opioid pain treatment, and it should be addressed quickly to prevent further complications. Call your doctor if you have constipation with opioid treatment.

This is not all the information you need to know about tramadol for safe and effective use. Review the full tramadol information here, and discuss this information and any questions with your doctor or other health care provider.

References

• Tramadol monograph. Drugs.com. Accessed Nov. 16, 2020 at https://www.drugs.com/ppa/tramadol.html
• Ultram [product information]. Janssen Pharmaceuticals, Inc. Updated July 16, 2020. Accessed Nov. 16, 2020 at https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=45f59e6f-1794-40a4-8f8b-3a9415924468

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Medical Disclaimer

Tramadol Side Effects: Nausea, Constipation, and More

Tramadol is an opioid painkiller used to treat chronic pain. When taken as prescribed, this medication is ingested every 4-6 hours; however, people who struggle with tramadol addiction may take it more often and at higher doses. Doctors adjust prescription doses so their patients do not consume more than 400 mg of tramadol per day.

More than this amount can cause severe side effects, including addiction, tolerance, and dependence.

While a person who takes tramadol as prescribed may develop some side effects, they are more likely to develop in people who struggle with addiction. General side effects from tramadol include:

• Flushing
• Dizziness
• Fatigue or sleepiness
• Sore throat
• Congestion
• Headache
• Itching
• Constipation
• Appetite changes or stomach upset
• Nausea or vomiting
• Physical weakness

Per the National Library of Medicine, in a double-blind study regarding the general side effects from tramadol, about 26 percent of people taking the medicine as directed developed diarrhea; 24 percent experienced nausea and vomiting; 18 percent had headaches; and 16 percent experienced excessive fatigue. Other side effects, like vomiting, itching, and sweating, occurred in less than 10 percent of study participants; dry mouth, indigestion, and diarrhea occurred in about 5 percent of study participants.

Tramadol can cause changes in the central nervous system, which could be disturbing or detrimental. These include:

• Anxiety
• Physical tremors
• Muscle spasms
• Emotional changes
• Hallucinations

These are very rare when tramadol is taken as directed; however, people who struggle with addiction to this narcotic may experience these side effects.

Some people may develop an allergy to tramadol, and this can cause symptoms like hives, difficulty breathing, mouth sores, rash, itchy eyes, and even convulsions. While this is rare, symptoms should be reported to doctors for emergency treatment immediately.

Other rare side effects include:

• Excess gas
• Urinary retention
• Frequent urination
• Bloating
• Blurry vision
• Trouble performing routine tasks
• Numbness or tingling, especially in the hands or feet
• Changes to physical sensations, especially decreased sensation
• Chest pain or discomfort
• Loss of balance
• Fainting
• Pain in the arms, jaw, legs, or back
• Trembling or shaking in the hands and feet
• Severe cramping
• Hallucinations, typically auditory
• Lack of oxygen to the extremities, leading to blue or clammy hands, feet, or nose
• Menstrual irregularities
• Vasodilation

If too much vasodilation occurs, blood pressure will drop, and the person may faint, suffer damage to the heart and blood vessels, and potentially experience organ damage, including brain damage from lack of oxygen.

People who abuse tramadol are at risk of suffering an opioid overdose. If a person survives opioid overdose, they may suffer liver failure, although this could be associated with taking acetaminophen at the same time as the narcotic. It is rare for opioid painkillers like tramadol to cause liver damage, but it has occurred in a small percent of cases.

Tramadol may also increase the risk of serotonin syndrome in people who take antidepressants, including SSRIs. It is unclear how this occurs, but it appears that tramadol enhances the effects of the antidepressant on releasing serotonin and preventing it from being reabsorbed. This causes serotonin to remain in the brain for too long. Many cases of serotonin syndrome clear up on their own, but very serious instances can cause high fever, irregular heartbeat, unconsciousness, or seizures.

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Last Updated on Jul 10, 2023

Tramadol for osteoarthritis | Cochrane

This translation is out of date. Please click here for the latest English version of this review.

This summary of the Cochrane Review presents what we know from research on the effects of tramadol on osteoarthritis. The review shows that:

There is gold level evidence that for the treatment of osteoarthritis, taking tramadol for up to three months can reduce pain, stiffness, and improve function and overall well-being. Tramadol can cause side effects such as nausea, vomiting, dizziness, constipation, fatigue and headache.

The benefits of tramadol are negligible and the side effects may cause people to stop taking it, which may limit the benefit of tramadol in the treatment of osteoarthritis.

What is osteoarthritis and what drugs are used to treat it?

Osteoarthritis (OA) is the most common form of arthritis and can affect the hands, hips, shoulders, and knees. In OA, the cartilage that protects the ends of bones breaks down and causes pain and swelling. There are two main types of drug treatment for OA. Painkillers (such as acetaminophen/paracetamol and opioids) are used to relieve pain, but they do not affect swelling. Non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and COX-II inhibitors) are used to reduce pain and swelling. Tramadol is one of the opioids most used in OA. It does not cause bleeding from the stomach and intestines, and does not cause kidney problems that can occur with other painkillers. It also does not affect the cartilage at the ends of bones. But tramadol does not reduce swelling and may not be effective with long-term use. Therefore, it is important to know the benefits and harms of tramadol.

What are the results of this review?

People in the studies took about 200 mg of tramadol per day, or a placebo (fake pill or powder), or an NSAID, or other pain medication. People took the medicines for one week to three months.

Benefits of tramadol

in people with osteoarthritis:

tramadol can reduce pain more than placebo

– tramadol can reduce pain by more than 8. 5 points on a scale of 0 to 100

tramadol may improve overall well-being more than placebo

– 50 out of 100 people may improve with placebo
– 69 out of 100 people may improve with tramadol

tramadol may reduce stiffness somewhat and improve function more than placebo

– function may improve by 0.32 points on a scale of 0 to 10 with tramadol

It is not known whether tramadol improves osteoarthritis symptoms more than other drugs. It is also unknown if tramadol is still effective with long-term use. This is due to the fact that the observations in the studies were short.

Harm of tramadol

in people with osteoarthritis:

tramadol may cause minor side effects in more people than placebo, such as nausea, vomiting, dizziness, constipation, fatigue, and headache

– 18 out of 100 people may have minor side effects when placebo
– 39 out of 100 people may have minor side effects when taking tramadol

tramadol can cause serious side effects that would cause people to stop taking it

– 8 out of 100 people had serious side effects with placebo
– 21 out of 100 people had serious side effects with tramadol

It is not known if tramadol causes more side effects than other osteoarthritis medications.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

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Translation notes:

Translation notes: Translation: Aleksandrova Elvira Grigoryevna. Editing: Gamirova Rimma Gabdulbarovna, Ziganshina Lilia Evgenievna. Russian translation project coordination: Kazan Federal University. For questions related to this transfer, please contact us at: [email protected]

Tramadol tablets for oncology – instructions for use, reviews, reaction in cancer patients to the drug

Tramadol is an effective pain reliever that belongs to soft drugs. It is difficult to get a prescription for it, but it is often impossible for cancer patients to do without this drug.

Oncology and pain syndrome

Drug therapy of pain syndrome in oncology is carried out in accordance with some fundamental principles: pain in 90% of patients;

Oral: Oral (swallowed) dosage forms are preferred, as are other non-injectable forms.

Description and pharmacological effects of Tramadol

Tramadol is a weak opioid analgesic similar to morphine, only weaker. This compound is a derivative of cyclohexanol. Once in the body, it binds to opioid prescriptions and blocks the transmission of pain impulses to the spinal cord. In addition, this drug has a sedative (sedative) and antitussive effect. Thus, after the introduction of Tramadol, the patient not only ceases to experience pain, but also calms down, can sleep normally.

Indications for the use of Tramadol

Tramadol is prescribed for various conditions that are accompanied by very severe pain, with the ineffectiveness of drugs from the NSAID group:

• injuries;
• oncological diseases;
• myocardial infarction;
• postoperative period;
• neuralgia.

Tramadol in oncological practice

Tramadol according to the rules of the “anaesthesia ladder” recommended by WHO, is prescribed in the second line – after the use of nonsteroidal drugs (NSAIDs).

Long-term use of opiates is addictive. But cancer patients should not be afraid of this side effect – provided that they are used strictly according to indications, adequate dosage and regimen.

Pharmacokinetics

Tramadol enters the body in an inactive form and only in the liver is converted into ten inactive metabolites and one active, which reduces pain intensity and disrupts the transmission of pain impulses in the spinal cord.

Of the tablets and drops taken, 68% of the medicine reaches the “sore spot”, all 100% are delivered by blood when injected. The disintegrated drug is excreted by 90% by the kidneys and 10% through the intestines, therefore, with renal failure, it can linger in the blood and tissues for a long time.

After taking a tablet or drops, the analgesic effect will appear after a quarter of an hour, after a maximum of half an hour, and will last almost 6 hours, Tramadol-retard acts up to 12 hours. The drug is highly effective, but over time the body decomposes it more actively, which requires an increase in the dose. If tramadol does not help at all, then a transition to stronger narcotic analgesics is required.

How to use the medicine?

Unlike most narcotic analgesics, Tramadol has several dosage forms. You can swallow capsules and tablets, and two types of solutions are also available: in drops for oral administration and in ampoules for injection.

In all cases, oral forms are preferred: injections are painful and, in patients weakened by a long illness, are associated with the possibility of developing an abscess even if complete sterility is observed – immunity works at half strength.

Tramadol drops begin to work very quickly, but they are easy to overdose. It is necessary to drip 20 drops onto a piece of sugar or into water – this is a dose for one dose. The second 20 drops are taken in the absence of pain relief within an hour after the first dose.

Capsule and tablet contains a full single dose. They are taken regardless of food. With unbearable pain syndrome, it is allowed to swallow two at once.

Long-acting tablet – Tramadol retard contains a doubled, tripled dose, and the largest one contains 4 single doses at once, which last up to 12 hours, but in especially difficult situations can be taken after 6 hours.

Ampoules contain 1 or 2 ml of solution, i.e. 50 mg or 100 mg of the drug. How often can you inject tramadol? Injections under the skin, into a muscle or vein are repeated no earlier than 4 hours later.

Contraindications

Stop using tramadol:

• if allergic to it;
• in case of alcohol and drug intoxication, overdose of psychotropic drugs;
• is incompatible with antidepressants from the group of MAO inhibitors due to the possibility of developing a severe serotonin syndrome;
• in severe renal failure, when the drug remains in the blood for a long time at a high concentration and an overdose may occur;
• in liver failure, the formation of the active metabolite is impaired.

Oncology and pain syndrome

90% of cancer patients experience pain of varying intensity, but it is not necessarily unbearable. Intolerable excruciating pain usually accompanies metastatic cancer, again, not in everyone, but with severe complications.

Duration of use

How long tramadol can be taken depends on the purpose for which it is prescribed. For example, after injuries and operations, it is used in a short course for several days, a maximum of weeks. In oncological diseases, the drug is used for a long time. It is important to strictly follow the instructions of the attending physician and immediately report all side effects.

Special instructions

During pregnancy Tramadol is prescribed only in short courses. Otherwise, the fetus may become addictive, and then the newborn child may experience a withdrawal syndrome. During breastfeeding, it is also necessary to take into account that a certain amount of the drug passes into breast milk.

Tramadol should be used with caution in case of impaired liver and kidney function .

Do not use the drug in children under 1 year of age. At the age of 1-14 years, dosages of 1 to 2 mg/kg are used. At the same time, prolonged forms of Tramadol should not be used in children under 14 years of age.

Tramadol should be used with caution in case of hypersensitivity to other opioid analgesics, confusion, drug dependence, convulsions.

The drug is incompatible with alcohol, drugs from the group of MAO inhibitors.

Tramadol reduces attention and reaction speed, therefore, during the course of treatment, you can not drive a car and engage in certain activities.

Side effects

Tramadol at therapeutic doses is well tolerated but may cause nausea , which is usually treated with conventional antiemetics – antiemetics.

In long-term treatment, especially in bedridden patients, constipation is possible , which is fought with enemas and laxatives.

Drowsiness and drowsiness are not always unfavorable for severe patients, they even help to some extent, however, this is a side effect.

The drug is characterized by excitation due to changes in the metabolism of serotonin – the “hormone of joy”.

Some patients find over time that this medicine no longer helps them effectively relieve pain and ask the doctor: “why doesn’t tramadol work?”. First, it is one of the weakest opioids. Secondly, as we mentioned above, with prolonged use, the body “gets used” to it and does not respond as well. If the pain syndrome can no longer be effectively controlled, this is an occasion to reconsider the treatment regimen, to include more powerful drugs in it.

Overdose

The maximum dose of Tramadol per day is not more than 400 mg, that is, four times 40 drops, or 8 capsules and regular tablets, 4 suppositories or 4 painkillers injections of tramadol, 2 ml each.

Exceeding the dose is accompanied by a change in consciousness – workload and even coma, convulsions, respiratory depression against the background of a strong heartbeat and a decrease in blood pressure are not excluded. To stop the condition, naloxone is used, convulsions are relieved by an injection of diazepam. Serotonin syndrome is treated with cyproheptadine.

Tramadol analogues

Tramadol and Tramal are the same drug from different manufacturers.

The combination of Tramadol with paracetamol from the group of NSAIDs is available under the names zaldiar, ramleps, tramaceta and forsodol.

How to replace tramadol in oncology? This question is best answered by the attending physician, who knows how the disease proceeds in a particular individual patient.

Only a doctor knows what needs to be done to make the painkiller Tramadol work in full force and with minimal risk to the patient’s health. But it is also important for the patient himself to have information about the drug in order to better understand the goals of treatment, follow the doctor’s prescriptions correctly, and notice side effects in time. Euroonco clinics use only original drugs with proven efficacy, and they are always in stock. Our doctors prescribe treatment in accordance with modern international recommendations.

Appointment for a consultation around the clock

+7 (495) 668-82-28

References:

1. Abuzarova G.R. /The role of tramadol in oncology and surgery// Abstracts X Ross. National congress “Man and medicine”; M.; 2003.
2. Abuzarova G.R., Gallinger E.Yu. Pchelintsev M.V. / Algorithm for pharmacotherapy of chronic pain syndrome in an oncological clinic // Vrach; 2011.-№ 6.
3. Pain ed. Yakhno N.N. / Guide for doctors / / Ed. Medpress info; 2009
4. Kogonia L.M., Voloshin A.G., Novikov G.A., Sidorov A.V. /Practical recommendations for the treatment of chronic pain syndrome in cancer patients // Malignant tumors: Practical recommendations RUSSCO #3s2, 2018 (vol. 8 ).
5. Osipova N.A., Abuzarova G.R. /Treatment of chronic pain in incurable patients at home// Doctor; 2002.-№ 4.
6. Novikov G.A., Osipova N.A. /Treatment of chronic pain of oncological genesis//Ed.