Therapy of chronic pain in cancer patients: Tafalgin use experience. Case report

Background. Chronic pain is the most common and severe condition associated with cancer, causing peripheral and central nervous system disorders Inadequate pain control can be destructive and negatively affect patients' quality of life and daily activity. Therefore, developing new drugs for complete pain control during antitumor therapy and palliative care is an urgent problem in modern oncology. One of these directions is the search for selective molecules that interact with 1-opioid receptors without many side effects of opioids. Aim. To evaluate the effectiveness of a new selective 1-opioid analgesic, Tafalgin, in treating chronic pain in a patient with pancreatic cancer. Materials and methods. Tafalgin was used to control chronic pain in a 60-year-old patient with stage IV pancreatic cancer, pT2 N0M1, with liver metastases, state after 10 cycles of polychemotherapy, and distal subtotal resection of the pancreas with splenectomy, progression in October 2022, liver metastases; state after 4 cycles of polychemotherapy, severe chronic pain. Results. The initial pain severity was evaluated using a visual analog scale: 7 points at rest and 9 points on exertion. The patient developed pain during FOLFIRINOX polychemotherapy, for which he received tramadol at a daily dose of 400 mg in combination with paracetamol, with an effect for 1.5 months. The pain severity increased with breakthrough pain. The patient was prescribed long-acting morphine at 60 mg/day, with good effect. However, the patient experienced nausea and vomiting. The morphine dose was reduced to 20 mg, thus resolving side effects and decreasing the effectiveness. Tafalgin was administered at a dose of 4 mg TID. The pain severity decreased to 11.2 points. No adverse events were reported. The patient has been receiving the drug for 52 days. His sleep and appetite have improved, physical activity has increased, and no weight loss has been reported. Conclusion. When switching a patient to Tafalgin, continuous adequate pain control is maintained, not inferior to morphine. Tafalgin is associated with a favorable safety profile.