Barbara Duncan, Germanus Natuhwera, Doris Nassuuna, Roselight Katusabe, Hanif Kasozi, Wilson Acuda
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引用次数: 0
Abstract
Background: Behaviour suggestive of addiction in some patients on long-term oral liquid morphine (OLM) caused concern amongst the Hospice Africa Uganda clinical team and prompted the survey. This survey aimed to identify serious adverse drug reactions to long-term OLM in patients with chronic pain receiving palliative care.
Methods: In Phase 1, the database of patients receiving palliative care at Hospice Africa Uganda was analyzed to find patients taking OLM from 12.7.2017 to 19.10.2017. A purposive review of their medical records was undertaken to identify those on long-term OLM. Phase 2 was conducted between 12.6.2018 and 23.10.2018. All patients on long-term OLM were offered biopsychosocial and spiritual assessment by a pain specialist (BD) to determine whether they were experiencing any serious adverse drug reactions. Phase 3 immediately followed phase 2 assessment. The pain specialist discussed with the participant any medication changes (including OLM) or other therapies to facilitate holistic management of pain for the individual.
Results: In phase 1, 653 patients on OLM were identified. Phase 2 identified 49 patients who were on long-term OLM. Thirty-four patients agreed to participate in the assessment with the pain specialist. Of the 34 participants, 24 had chronic non-cancer pain and two had chronic cancer pain. Eight cancer survivors had incidental chronic non-cancer pain. Serious adverse drug reactions were identified in four participants with chronic non-cancer pain. Two cases of addiction, one case of opioid hyperalgesia, and one probable diversion of morphine.
Conclusion: To our knowledge, the study identified the first documented cases of addiction to OLM in sub-Saharan Africa. Future research involving a larger multicenter sample, longitudinal, and qualitative designs is needed. Education of healthcare practitioners prescribing opioids should put equal emphasis on management of chronic non-cancer pain as do chronic cancer pain to minimize the risk of serious adverse reactions.
背景：一些长期口服液体吗啡（OLM）患者的成瘾行为引起了非洲乌干达临终关怀临床团队的关注，并促使了这项调查。本调查旨在确定接受姑息治疗的慢性疼痛患者长期OLM的严重药物不良反应。方法：在第一阶段，对乌干达非洲临终关怀医院（Hospice Africa Uganda）接受姑息治疗的患者数据库进行分析，找出2017年7月12日至2017年10月19日接受OLM治疗的患者。对他们的医疗记录进行了有目的的审查，以确定那些长期从事劳动管理的人。第二阶段于2018年6月12日至2018年10月23日进行。所有接受长期OLM治疗的患者均由疼痛专家（BD）进行生物心理社会和精神评估，以确定他们是否经历任何严重的药物不良反应。第三阶段紧随第二阶段评估。疼痛专家与参与者讨论任何药物改变（包括OLM）或其他治疗方法，以促进个人疼痛的整体管理。结果：在第1期，确定了653例OLM患者。第二阶段确定了49例长期OLM患者。34名患者同意参加疼痛专家的评估。在34名参与者中，24人患有慢性非癌性疼痛，2人患有慢性癌性疼痛。8名癌症幸存者有偶发的慢性非癌性疼痛。在4名慢性非癌性疼痛的参与者中发现了严重的药物不良反应。2例成瘾，1例阿片类药物痛觉过敏，1例吗啡可能分流。结论：据我们所知，该研究确定了撒哈拉以南非洲地区首次记录的OLM成瘾病例。未来的研究需要涉及更大的多中心样本，纵向和定性设计。对处方阿片类药物的医疗保健从业人员的教育应同等重视慢性非癌性疼痛的管理，以尽量减少严重不良反应的风险。
期刊介绍：
Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.
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