Mercadante Sebastiano, Bruera Eduardo
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy.
Cancer Treat Rev. 2006 Jun;32(4):304-15. doi: 10.1016/j.ctrv.2006.03.001. Epub 2006 Apr 19.
Cancer patients with pain may not respond to increasing doses of opioids because they develop adverse effects before achieving an acceptable analgesia, or the analgesic response is poor, despite a rapid dose escalation. Opioid switching may significantly improve the balance between analgesia and adverse effects. We conducted a systematic review of existing literature on opioid switching. According to available data, opioid switching results in clinical improvement in more than 50% of patients with chronic pain with poor response to one opioid. However, data are based on open studies or small case series. Reasons for switching may influence the dose of the alternative drug. Opioid conversion should not be a mere mathematical calculation, but just a part of a more comprehensive evaluation of pain, adverse effect intensity, comorbidities, and concomitant drugs. The process of reaching an optimal dose should be highly individualized, particularly when patients are switched from high doses of opioids, given the wide conversion ratios reported in literature.
患有疼痛的癌症患者可能对不断增加剂量的阿片类药物没有反应，因为他们在获得可接受的镇痛效果之前就出现了不良反应，或者尽管剂量迅速增加，但镇痛反应仍然很差。阿片类药物转换可能会显著改善镇痛效果与不良反应之间的平衡。我们对现有的关于阿片类药物转换的文献进行了系统综述。根据现有数据，阿片类药物转换使超过50%对一种阿片类药物反应不佳的慢性疼痛患者的临床症状得到改善。然而，数据基于开放性研究或小病例系列。转换的原因可能会影响替代药物的剂量。阿片类药物转换不应仅仅是数学计算，而应只是对疼痛、不良反应强度、合并症和伴随用药进行更全面评估的一部分。达到最佳剂量的过程应该高度个体化，尤其是当患者从高剂量阿片类药物转换时，因为文献报道的转换比例范围很广。
