Bruera Eduardo, Fainsinger Robin, MacEachern Tara, Hanson John
Palliative Care Program, Edmonton General Hospital, University of Alberta, Department of Epidemiology, Cross Cancer Institute, Edmonton, Alberta T5K 0LA Canada.
Pain. 1992 Jul;50(1):75-77. doi: 10.1016/0304-3959(92)90114-Q.
In this open, uncontrolled trial, 15 patients with severe incident cancer pain receiving regular opiates were administered 10 mg oral methylphenidate (MP) at 08.00 h and 15 mg at 12.00 h in order to antagonize opiate-induced sedation. The daily dose of opiate was increased by 30% 24 h after starting MP, followed by a 10% increase twice a day until maximal tolerated dose. In 14 evaluable patients, pain (VAS 0-100 mm), sedation (VAS), and mean equivalent daily dose (MEDD) of morphine were 55 +/- 17, 65 +/- 18 and 248 +/- 150 48 h before MP, versus 38 +/- 12 (P less than 0.01), 42 +/- 12 (P less than 0.01), and 405 +/- 130 (P less than 0.01) 48 h after MP, respectively. After 48 h of treatment, 12 of 14 patients felt better on MP, 2 of 12 patients felt no difference, and no patients felt worse (P less than 0.05). We conclude that the addition of MP allowed for an increase in the MEDD of morphine and increased pain control. Controlled double-blind trials should be performed.
在这项开放性、非对照试验中，15名接受常规阿片类药物治疗的重度突发性癌痛患者于08:00口服10毫克哌醋甲酯（MP），并于12:00口服15毫克，以对抗阿片类药物引起的镇静作用。在开始服用MP后24小时，阿片类药物的每日剂量增加30%，随后每天增加10%，直至最大耐受剂量。在14名可评估患者中，服用MP前48小时，疼痛（视觉模拟评分0 - 100毫米）、镇静（视觉模拟评分）和吗啡平均等效日剂量（MEDD）分别为55±17、65±18和248±150，而服用MP后48小时分别为38±12（P<0.01）、42±12（P<0.01）和405±130（P<0.01）。治疗48小时后，14名患者中有12名感觉服用MP后病情好转，12名患者中有2名感觉无差异，没有患者感觉病情恶化（P<0.05）。我们得出结论，添加MP可增加吗啡的MEDD并增强疼痛控制。应进行对照双盲试验。
