Time to Pain Relief After Immediate-Release Morphine in Episodic Pain
Time to Pain Relief After Immediate-Release Morphine in Episodic Pain
复制标题
阵发性疼痛立即释放吗啡后缓解疼痛的时间
DOI：
10.2165/1158412-s0-000000000-00000
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发表时间：
2010
影响因子：
3.2
通讯作者：
M. Mammucari
中科院分区：
文献类型：
--
作者：
C. Presti;A. Roscetti;Davide Muriess;M. Mammucari
背景：癌症相关和非癌症慢性疼痛是临床实践中最常见的挑战。慢性疼痛和突破性疼痛(BTP)的治疗需要调整止痛方案以实现充分的疼痛控制。
目的：研究尽管使用止痛药进行基线治疗，但仍经历剧烈阵发性疼痛发作的患者达到疼痛缓解的时间。
方法：本研究基于14天的观察期。癌症相关或非癌症相关疼痛的患者每天经历2次密集发作的疼痛发作，每4小时(全天候)开一次即时释放(IR)硫酸吗啡(根据需要)(10毫克至20毫克)，并允许一次IR吗啡救援量(相当于固定时间服用剂量的一次额外给药)。患者在日常日记中记录给药时间和部分或全部缓解阵发性疼痛发作所需的时间；在一个研究中心，日记由专门的医务人员帮助管理。疼痛强度和总体幸福感分别用数字评定量表(NRS)和卡诺夫斯基表现量表(Karnofsky Performance Scale)评估。不良事件和睡眠模式也被记录下来。
结果：85例患者平均年龄(62.67±14.3)岁，其中14例为非癌症退行性疾病引起的疼痛，71例为癌性疼痛。随着背景疼痛的稳定，日常疼痛的强度有所改善；癌症组(从5.63%到1.98%)和非癌症组(从8.00%到1.00%)的NRS从基线下降到第14天(P<；0.0001)。患者的总体幸福感也随之增加。全天候治疗导致每天剧烈发作疼痛的数量立即减少，11.8%的患者在24小时内完全缓解疼痛。癌症组平均每天发作剧烈疼痛的次数稳步减少，在第14天达到显著水平(与基线相比，P<；0.001)。此外，剧烈阵发性疼痛发作实现部分和全部疼痛缓解的时间显著改善。在14天的观察期内，不良事件和睡眠模式有所改善。
结论：使用全天候IR吗啡治疗癌症相关或非癌症相关的背景疼痛可以减少剧烈发作的疼痛发作，而使用解救剂量的IR吗啡可以更快地控制疼痛发作，这表明‘末次剂量’疼痛不应被归类为BTP。
AbstractBackground: Cancer-related and non-cancer chronic pain embodies the most frequent challenge in clinical practice. Management of chronic pain and breakthrough pain (BTP) requires adjustments to the analgesic regimen to achieve adequate pain control.
Objective: To examine the time to achieve pain relief in patients who experienced intense episodic pain breakouts despite baseline therapy with analgesics.
Methods: This study was based on a 14-day observation period. Patients with either cancer-related or non-cancer pain who experienced >2 intensive episodic pain breakouts per day were prescribed immediate-release (IR) morphine sulphate (10 mg to 20 mg as needed) every 4 hours (around-the-clock) and allowed one rescue dose of IR morphine (equal to one additional administration of the dosage taken at fixed times) for any episodic pain breakouts. Patients recorded time of administration and time taken to achieve partial or total relief of episodic pain breakout in daily diaries; in one study centre the diary was managed with the help of specialized medical attendants. Pain intensity and general wellbeing were assessed by a Numerical Rating Scale (NRS) and Karnofsky Performance Scale, respectively. Adverse events and sleep patterns were also recorded.
Results: Of 85 patients (mean age 62.67 ± 14.3 years) enrolled, 14 experienced pain from non-cancer degenerative diseases, and 71 had cancer-related pain. Following stabilization of background pain, the intensity of daily pain improved; NRS decreased from baseline to day 14 for cancer (from 5.63 to 1.98) and non-cancer (from 8.00 to 1.00) groups (both p < 0.0001). Patients’ general wellbeing increased concomitantly. Around-the-clock therapy resulted in an immediate decrease in the number of intense episodic pain breakouts per day, with 11.8% of patients achieving total pain relief within 24 hours. The mean number of intense episodic pain breakouts per day decreased steadily in the cancer group, reaching significance at day 14 (p < 0.001 vs baseline). Moreover, the time to achieve partial and total pain relief of intense episodic pain breakouts improved significantly. Adverse events and sleep patterns improved over the 14-day observation period.
Conclusions: Stabilization of background cancer-related or non-cancer pain with around-the-clock IR morphine therapy resulted in fewer intense episodic pain breakouts, which were more quickly managed with rescue-dose IR morphine, suggesting that ‘end-dose’ pain should not be classified as BTP.