癌症患者吗啡剂量和疼痛强度的长期模式。

P Sloan, R Melzack
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引用次数: 43

摘要

癌症疼痛仍然是一个世界性的问题,一些患者由于对耐受性和药物依赖的担忧而继续用药不足。本研究的目的是记录住院姑息治疗病房慢性癌症疼痛患者的吗啡摄入量,并描述该患者群体中吗啡使用和疼痛强度的长期模式。经IRB批准和书面知情同意,在蒙特利尔皇家维多利亚医院姑息治疗部门住院64周以上的患者是本研究的候选人。接受吗啡治疗30天或更长时间且能够完成疼痛量表的癌症患者也包括在内。排除了感觉混乱或浑浊的患者。采用McGill疼痛问卷的PPI(0-5分)记录每日疼痛强度。记录每日吗啡用量,并记录突破痛的发生和强度。在35名潜在的研究候选人中,17名平均年龄为59(14)岁的患者完成了研究。患者平均随访82(52)天。研究开始时吗啡的平均日剂量为135 (127)mg,研究结束时吗啡的平均日剂量为244 (240)mg。没有证据表明任何病人对吗啡迅速产生耐受性。大多数患者的疼痛得到了很好的控制。17例患者中有10例,93%报告PPI评分为0或1。10例患者中有4例偶尔出现突破性疼痛。另外4名患者报告称,79%的PPI评分为0或1分,18%的PPI评分为2分(不舒服)或3分(令人不安),因此82%的患者疼痛控制良好至极好。17名患者中有3人在病房里待了4个多月,疼痛控制不佳。所有这些患者都有神经性癌症疼痛。这些结果支持这样的结论,即大多数癌症患者的疼痛得到了很好的控制,并且每天吗啡剂量的增加,当它发生时,通常是在几周到几个月的时间内发生的,并且吗啡剂量的快速上升模式不会发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term patterns of morphine dosage and pain intensity among cancer patients.

Cancer pain remains a worldwide problem and some patients continue to be undermedicated because of concerns about tolerance and drug dependence. The aim of this study was to document the morphine intake of patients with chronic cancer pain in an inpatient palliative care unit and to describe the long-term pattern of morphine use and pain intensity in this patient population. With IRB approval and written informed consent, patients admitted over a 64-week period to the palliative care unit at the Royal Victoria Hospital, Montreal, were candidates for this study. Cancer patients receiving morphine for 30 days or longer who were able to complete the pain scale were included. Excluded were patients with a confused or clouded sensorium. Daily pain intensity was recorded by the PPI (0-5 scale) of the McGill pain questionnaire. The daily morphine consumption was recorded and the occurrence and intensity of breakthrough pain were also recorded. Of the 35 potential candidates for study, 17 patients with a mean age of 59 (14) years completed the study. Patients were followed up for a mean of 82 (52) days. The mean (S.D.) daily morphine dosage at study entry was 135 (127) mg, and the daily morphine dose at study completion was 244 (240) mg. There was no evidence that any patient rapidly developed tolerance to morphine. Pain was well controlled for most patients. For 10 of 17 patients, 93% reported PPI scores of either 0 or 1. Occasional breakthrough pain was experienced by 4 of these 10 patients. Four other patients reported 79% of their PPI scores as either 0 or 1, and 18% of the PPI scores as either 2 (discomforting) or 3 (disturbing), Thus 82% of patients had good to excellent pain control. Three of 17 patients spent more than four months in the unit and had less than good pain control. All of these patients had neuropathic cancer pain. These results support the conclusion that pain was well controlled for most cancer patients, and that increases in daily morphine dose, when it occurred, generally developed over a period of weeks to months, and a pattern of rapid escalation in morphine dose did not occur.

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