Sebastiano Mercadante, Giorgio Sapienza, Alessio Lo Cascio, Alessandra Casuccio
{"title":"阿片类药物在急性姑息治疗单位的使用以重新评估处方。","authors":"Sebastiano Mercadante, Giorgio Sapienza, Alessio Lo Cascio, Alessandra Casuccio","doi":"10.1007/s40122-025-00728-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.</p><p><strong>Methods: </strong>Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).</p><p><strong>Results: </strong>A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.</p><p><strong>Conclusions: </strong>An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions.\",\"authors\":\"Sebastiano Mercadante, Giorgio Sapienza, Alessio Lo Cascio, Alessandra Casuccio\",\"doi\":\"10.1007/s40122-025-00728-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.</p><p><strong>Methods: </strong>Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).</p><p><strong>Results: </strong>A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.</p><p><strong>Conclusions: </strong>An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. 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The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions.
Introduction: This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.
Methods: Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).
Results: A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.
Conclusions: An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.
期刊介绍：
Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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