Schug S A, Zech D, Grond S, Jung H, Meuser T, Stobbe B
J Pain Symptom Manage. 1992 Jul;7(5):259-66. doi: 10.1016/0885-3924(92)90059-q.
We surveyed 550 cancer patients who experienced pain and were treated with morphine for a total of 22,525 treatment days. Sufficient pain relief was achieved during more than 80% of this time using an average oral morphine dose of 82.4 mg--significantly lower than other studies. The use of this low dose, which was possible due to the concomitant administration of nonopioids and specific coanalgesics in most patients, resulted in a low incidence of side effects. Constipation and nausea/vomiting were the most common of these side effects. Physical dependence posed no practical problem in discontinuation of morphine treatment. Long-term opioid intake and development of tolerance did not appear to be linked; an increase in morphine dosage was most often explained by progression of the terminal disease. Addiction was a negligible problem, with only one observed case.
我们对550名经历疼痛并接受吗啡治疗的癌症患者进行了调查，这些患者总共接受了22525个治疗日的治疗。在超过80%的治疗时间内，使用平均口服吗啡剂量82.4毫克实现了充分的疼痛缓解——这一剂量显著低于其他研究。由于大多数患者同时使用了非阿片类药物和特定的辅助镇痛药，才得以使用这种低剂量，从而使副作用的发生率较低。便秘和恶心/呕吐是这些副作用中最常见的。身体依赖性在停用吗啡治疗时并未造成实际问题。长期服用阿片类药物与耐受性的发展似乎没有关联；吗啡剂量增加最常见的原因是终末期疾病的进展。成瘾是一个可忽略不计的问题，仅观察到一例。
