Galer Bradley S, Coyle Nessa, Pasternak Gavril W, Portenoy Russell K
Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 USA.
Pain. 1992 Apr;49(1):87-91. doi: 10.1016/0304-3959(92)90192-E.
Although it is widely appreciated that patients can demonstrate highly variable responses to different opioid drugs, there have been few detailed descriptions of this phenomenon. To illustrate this variability, we present 5 patients, 4 with cancer pain and 1 with non-malignant pain, who underwent dose titration with more than 1 opioid and developed markedly different responses to each. In every case, dose escalation led to successful treatment with 1 opioid and to intolerable side effects without adequate relief with others. The existence of this individual variability in the response to different opioids has important implications for both clinical practice and current understanding of opioid pharmacology in man. It contradicts the view that any opioid is inherently more efficacious than any other, suggests that patients who fail to obtain adequate pain relief at maximally tolerated doses of 1 opioid may benefit from an alternative drug, and underscores the potential importance of genetic factors as a determinant of opioid response.
尽管人们普遍认识到患者对不同阿片类药物的反应可能差异很大，但对此现象的详细描述却很少。为了说明这种变异性，我们介绍5例患者，其中4例患有癌痛，1例患有非恶性疼痛，他们接受了不止一种阿片类药物的剂量滴定，并且对每种药物产生了明显不同的反应。在每种情况下，剂量增加都会使一种阿片类药物治疗成功，而使用其他药物则会出现无法耐受的副作用且疼痛未得到充分缓解。这种对不同阿片类药物反应的个体变异性的存在，对临床实践和当前对人体阿片类药物药理学的理解都具有重要意义。它与任何一种阿片类药物本质上比其他药物更有效的观点相矛盾，表明在一种阿片类药物的最大耐受剂量下未能获得充分疼痛缓解的患者可能会从另一种药物中获益，并强调了遗传因素作为阿片类药物反应决定因素的潜在重要性。
