Opioids switching with transdermal systems in chronic cancer pain.
Opioids switching with transdermal systems in chronic cancer pain.
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DOI：
10.1186/1756-9966-28-61
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发表时间：
2009-05-07
期刊：
影响因子：
--
通讯作者：
Passavanti MB
中科院分区：
文献类型：
--
作者：
Aurilio C;Pace MC;Pota V;Sansone P;Barbarisi M;Grella E;Passavanti MB
由于耐受性的发展和不良副作用，慢性疼痛患者经常需要切换到替代阿片类药物治疗，以评估替代经皮应用（TDS）阿片类药物对慢性癌性疼痛患者的疗效和耐受性。共有32名患者接受了替代阿片类药物治疗，16名患者从丁丙诺啡切换到芬太尼，16名患者从芬太尼切换到丁丙诺啡。所使用的剂量为等效转换表中所示剂量的50%。在接下来的3周中，每隔一周评估一次疼痛缓解情况，通过VAS、PPI和PRI评估，所有患者在所有3次随访中疼痛缓解均显著改善（p < 0.0001）。治疗3周后，芬太尼组和丁丙诺啡组VAS、PPI和PRI平均评分分别下降68、77、74和69、79和62%。在同一时间段内，芬太尼组和丁丙诺啡组口服吗啡作为抢救用药的剂量分别从27.5±20.5 mg/d （mean±SD）降至3.75±8.06 mg/d, 33.8±18.9 mg/d降至3.75±10.9 mg/d。两组患者在止痛和急救药物的使用上均无显著差异，研究期间出现不良事件的患者数量有所下降。治疗第3周后，芬太尼组便秘患者由11例减少到5例，丁丙诺啡组便秘患者由10例减少到4例。恶心和呕吐的发生率也有类似的减少。治疗一周后，未见任何患者镇静。阿片类药物切换在50%的计算等镇痛剂量产生显著减少疼痛水平和抢救药物。副反应发生率降低，未见新的副反应。需要进一步的研究来根据不同类型的癌症为患者提供个性化的治疗。
Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks Pain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment. Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.
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