Monitoring of opioid therapy in advanced cancer pain patients
Monitoring of opioid therapy in advanced cancer pain patients
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DOI：
10.1016/s0885-3924(96)00302-8
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发表时间：
1997-04-01
影响因子：
4.7
通讯作者：
Agnello, A
中科院分区：
文献类型：
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作者：
Mercadante, S;Dardanoni, G;Agnello, A
到目前为止，还没有任何参数来监测癌症疼痛患者的阿片类药物治疗。在这项研究中，325名连续的晚期癌症患者被安排进行前瞻性纵向调查。排除后，对67名患者进行了调查。所有纳入的患者都是晚期癌症患者，疼痛在死亡前需要阿片类药物治疗超过6周。记录阿片类药物升级、与阿片类药物治疗相关的症状、疼痛机制和疼痛强度。计算指数以对阿片类药物的反应进行分类。阿片类药物升级指数(OEI)被用来指示阿片类药物起始剂量的平均增加，以百分比或毫克表示。同时测定镇痛剂的稳定期(MLD)和有效止痛评分(EAS)，即固定时间间隔计算的止痛药消耗量/止痛率。平均视觉模拟评分(VAS)<4且有规律的OEI和EAS的患者被认为是有反应的；平均VAS<4但OEI>5或与前一周计算的EAS相比增加超过100%的患者被认为是轻度反应；VAS平均超过4的患者被认为无反应。高龄、女性和既往化疗都是降低OEI的因素。头颈癌与较高的OEI相关。关于阿片类药物相关症状的影响，OEI的增加与困惑的存在有关。此外，精神错乱的出现与神经性疼痛有关。然而，单独使用神经病理性疼痛并不影响这一得分。特定性别的癌症，如乳腺癌，影响了报告的MLD的性别差异(显著长于报告的男性和其他原发肿瘤)。有效28例，部分有效33例，无效6例。心理因素与疼痛缓解效果不佳有关，可能会降低患者的依从性。这项研究中使用的工具可能有助于监测阿片类药物治疗对癌症疼痛患者的影响。简单的数字很容易比较，并使其有可能概述阿片类药物的反应和患者之间的差异。(C)美国癌症疼痛缓解委员会，1997年。
Until now, there have not been any parameters to monitor opioid therapy in cancer-patients with pain. In this study, 325 consecutive advanced cancer patients were scheduled for a prospective longitudinal survey. After exclusions, 67 patients were surveyed. All included patients were advanced cancer patients with pain that required opioid therapy for more than 6 weeks before death. Opioid escalation, symptoms associated with opioid therapy, pain mechanism and pain intensity were recoded. indices were calculated to categorize the response to opioids. The opioid escalation index (OEI) was used to index the mean increase of the starting opioid dosage, expressed as a percentage or in mg. The length of the period of stable dose (MLD) and the effective analgesic score (EAS), that is, the analgesic consumption/pain relief ratio calculated at fixed intervals, were also used. Patients with a mean visual analogue scale score (VAS) of less than 4 and regular OEI and EAS were considered responsive; patients with a mean VAS less than 4 but with an OEI more than 5 or increases of more than 100% of EAS when compared to that calculated the week before were considered mildly responsive; and patients with a mean VAS more than 4 were considered unresponsive.Advanced age, female gender and previous chemotherapy were all factors reducing OEI. Head and neck cancer was associated with a higher OEI. Regarding the influence of the opioid-related symptoms, an increased OEI was associated with the presence of confusion. Moreover the presence of confusion was associated with neuropathic pain. Neuropathic pain taken alone, however did not influence this score. Gender-specific cancer, such as breast cancer; influenced the gender differences reported for MLD (significantly longer than that reported for males and other primary tumor). Good responsiveness was observed in 28 patients, partial responsiveness in 33 patients unresponsiveness in six patients. Psychological factors were associated with poor pain relief, probably reducing the patient's compliance. The tools used in this study may be useful in monitoring the effects of opioid therapy in cancer pain patients. Simple numbers are easy to compare and make it possible to profile opioid responsiveness ansi differences among patients. (C) U.S. Cancer Pain Relief Committee, 1997.