低剂量添加美沙酮治疗癌症疼痛:对 102 名日本患者的回顾性分析。

IF 1.9 4区 医学 Q3 ONCOLOGY
Tetsumi Sato, Akira Fukutomi, Taiichi Kawamura, Kyohei Kawakami, Tetsu Sato, Yoshiko Kamo, Tomomi Suzuki, Shota Hagiya, Rei Tanaka
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引用次数: 0

摘要

背景:美沙酮于 2013 年在日本被引入用于治疗顽固性癌痛,适用于接受阿片类药物剂量≧60 毫克/天的患者,作为口服吗啡等效物。据报道,欧洲国家在使用阿片类药物的基础上加用低剂量(≦10 毫克/天)美沙酮,可成功缓解各种类型的顽固性癌痛;但在日本,此类药物的使用报道很少。本研究旨在分析日本癌症患者使用低剂量美沙酮治疗顽固性疼痛的百余例病例:方法:提取我院姑息治疗小组或姑息医学科在 2016 年 4 月至 2023 年 9 月期间,在先前阿片类药物基础上添加 5 或 10 毫克/天美沙酮的所有病例,并对电子病历进行回顾性分析:共提取102例,男女比例为60:42,年龄(平均±SD)为(62.8±14.7)岁。86名患者在住院期间使用了美沙酮。引起顽固性疼痛的主要病变是脊柱转移(48例)、骨盆或骨盆底病变(29例)以及胸膜和/或胸壁病变(16例)。最常见的疼痛机制是躯体疼痛和神经性疼痛的混合。在使用美沙酮之前,46 名患者使用的主要阿片类药物包括他喷他多(tapentadol),36 名患者使用氢吗啡酮(hydromorphone),19 名患者使用羟考酮(oxycodone)。之前阿片类药物的剂量[中位数(四分位数间距:IQR)]为97(62.8-167.3)(范围:15-1313)毫克/天(口服吗啡当量)。分别有48名、22名和11名患者同时接受了放疗、化疗和神经阻滞治疗(有一些重叠)。美沙酮开始使用七天后,抢救剂量[中位数(IQR)]明显减少,从美沙酮使用前一天的3次(2至5次)减少到1次(0至4次)。导致停用美沙酮的副作用有 3 例嗜睡、3 例恶心和 1 例头晕(有一些重叠)。与完全更换其他阿片类药物相比,小剂量添加美沙酮可减少出现重大剂量差异的可能性,并可通过联合减少/增加阿片类药物来快速调整剂量。小剂量添加美沙酮是治疗难治性癌痛的一种有效而安全的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Low-dose add-on methadone for cancer pain management: a retrospective analysis of 102 Japanese patients.

Background: Methadone was introduced in 2013 for the treatment of intractable cancer pain in Japan and is indicated for patients receiving opioid doses ≧60 mg/day as an oral morphine equivalent. Low-dose (≦10 mg/day) add-on methadone to prior opioids has been reported from European countries to successfully relieve various types of intractable cancer pain; however, there are few reports of such use in Japan. The aim of this study was to analyze more than a hundred cases with low-dose add-on methadone to treat intractable pain in Japanese cancer patients.

Methods: All cases in which 5 or 10 mg/day of methadone was added to prior opioids by the Palliative Care Team or Division of Palliative Medicine in our hospital during the period between April 2016 and September 2023 were extracted and analyzed retrospectively on electrical medical charts.

Results and conclusions: A total of 102 cases were extracted with a male-to-female ratio of 60:42, and the age (mean ± SD) was 62.8 ± 14.7 years old. Methadone was introduced in an inpatient setting to 86 patients. The major pathologies that caused intractable pain were spinal metastases in 48, pelvis or pelvic floor lesions in 29 and pleural and/or chest wall lesions in 16. The most common mechanism of pain was the mixture of somatic and neuropathic components. The major opioids administered prior to methadone included tapentadol in 46 patients, hydromorphone in 36 and oxycodone in 19. The dose of the prior opioids [median, (interquartile range: IQR)] was 97, (62.8-167.3) (range: 15-1313) mg/day of oral morphine equivalent. Radiotherapy, chemotherapy and nerve blocks were performed as concomitant therapies in 48, 22 and 11 patients, respectively (with some overlap). The number of rescue doses [median (IQR)] was significantly decreased from three (two to five) on the day before methadone to one (zero to four) after seven days from methadone initiation. The side effects leading to discontinuation of methadone were drowsiness in three cases, nausea in three cases and dizziness in one case (with some overlap). Compared with complete switching from other opioids, low-dose add-on methadone can reduce the possibility of major dose discrepancies and can be quickly adjusted by combined opioid reduction/increase. Low-dose add-on methadone can be an effective and safe method for intractable cancer pain.

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来源期刊
CiteScore
3.70
自引率
8.30%
发文量
177
审稿时长
3-8 weeks
期刊介绍: Japanese Journal of Clinical Oncology is a multidisciplinary journal for clinical oncologists which strives to publish high quality manuscripts addressing medical oncology, clinical trials, radiology, surgery, basic research, and palliative care. The journal aims to contribute to the world"s scientific community with special attention to the area of clinical oncology and the Asian region. JJCO publishes various articles types including: ・Original Articles ・Case Reports ・Clinical Trial Notes ・Cancer Genetics Reports ・Epidemiology Notes ・Technical Notes ・Short Communications ・Letters to the Editors ・Solicited Reviews
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