Immediate- or sustained-release morphine for dose finding during start of morphine to cancer patients:: a randomized, double-blind trial
Immediate- or sustained-release morphine for dose finding during start of morphine to cancer patients:: a randomized, double-blind trial
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DOI：
10.1016/s0304-3959(02)00328-7
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发表时间：
2003-01-01
期刊：
影响因子：
7.4
通讯作者：
Borchgrevink, PC
中科院分区：
文献类型：
--
作者：
Klepstad, P;Kaasa, S;Borchgrevink, PC
在开始口服吗啡治疗癌症疼痛时，推荐使用立即释放的吗啡每4小时一次的滴定程序。这一建议不是基于对照研究的证据，许多医生开始使用控释吗啡进行吗啡治疗。我们纳入了40名接受阿片类药物治疗的恶性疾病和疼痛患者，这些患者接受了轻到中度疼痛的治疗，这是一项随机、双盲、双模拟、平行分组研究，比较了滴定与每4小时一次的速释吗啡，以及每日一次的缓释吗啡的滴定。主要终点是达到充分缓解疼痛所需的时间，次要终点是其他症状(恶心、疲倦、睡眠不足、眩晕、食欲和便秘)、与健康相关的生活质量和患者满意度。使用速释吗啡的平均滴定时间为2.1(95%CI；1.4-2.7)天，使用缓释吗啡的平均滴定时间为1.7(95%CI；1.1-2.3)天。立即释放滴定的患者在滴定结束时报告有统计学意义的更多的疲倦。我们没有观察到两种治疗方法在不良反应或与健康相关的生活质量功能方面的其他差异。据报道，全球对吗啡治疗也有类似的满意。总而言之，每天使用一次缓释吗啡的简化滴定与每4小时一次的速释吗啡同样有效。(C)2002年国际疼痛研究协会。爱思唯尔科学公司出版。版权所有。
A titration procedure using immediate-release morphine given 4-hourly is recommended during start of oral morphine for cancer pain. This recommendation is not based on evidence from controlled studies, and many physicians start morphine treatment with controlled-release morphine. We included 40 patients with malignant disease and pain despite treatment with opioids for mild to moderate pain in a randomized, double-blind, double-dummy, parallel-group study comparing titration with immediate-release morphine given 4-hourly with titration with sustained-release morphine given once daily. The primary end point was the time needed to achieve adequate pain relief Secondary end points were other symptoms (nausea, tiredness, lack of sleep, vertigo, appetite and constipation), health related quality of life and patient satisfaction. The mean times needed for titration were 2.1 (95% CI; 1.4-2.7) days using immediate-release morphine and 1.7 (95% CI; 1.1-2.3) days using sustained-release morphine. Patients titrated with immediate-release reported statistically significant more tiredness at the end of titration. We observed no other differences in adverse effects or health related quality of life functions between the two treatments. Similar global satisfactions with the morphine treatments were reported. In conclusion, a simplified titration using sustained-release morphine once daily is equally effective as immediate-release morphine given 4-hourly. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.