Ross E L, Hahn K
Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, MA 02467, USA.
Int J Clin Pract. 2008 Mar;62(3):471-9. doi: 10.1111/j.1742-1241.2007.01688.x.
Chronic pain, one of the most common reasons for which patients seek medical attention, is defined as pain that persists beyond the normal healing time, usually about 3 months. Chronic pain can be malignant or nonmalignant in origin, or can appear in the absence of identifiable pathology. Pharmacological treatment options include non-opioid and opioid analgesics, as well as adjuvant medications. Opioids, the most potent analgesics, are typically reserved for the treatment of chronic, moderate-to-severe pain that has not responded to non-opioid therapy. Morphine remains the gold standard among commonly used opioids. Long-acting opioids are formulated to offer continuous delivery of analgesia around the clock. These agents are formulated to maintain therapeutic blood levels of morphine, with minimal fluctuations. KADIAN Capsules, which contain polymer-coated extended-release morphine sulfate pellets, is one such formulation available for the treatment of moderate-to-severe pain for which an analgesic is indicated for more than a few days. This article reviews KADIAN and identifies unique features from early pharmacokinetic and pharmacodynamic studies, recent data on pharmacokinetic interactions with alcohol and results from recent trials in treating nonmalignant pain.
慢性疼痛是患者寻求医疗关注的最常见原因之一，被定义为持续超过正常愈合时间（通常约3个月）的疼痛。慢性疼痛的起源可以是恶性或非恶性的，也可能在没有可识别的病理情况下出现。药物治疗选择包括非阿片类和阿片类镇痛药以及辅助药物。阿片类药物是最有效的镇痛药，通常用于治疗对非阿片类治疗无反应的慢性中度至重度疼痛。吗啡仍然是常用阿片类药物中的金标准。长效阿片类药物的设计目的是提供全天候的持续镇痛。这些制剂旨在维持吗啡的治疗血药浓度，波动最小。KADIAN胶囊含有聚合物包衣的缓释硫酸吗啡微丸，是一种可用于治疗中度至重度疼痛且需要使用镇痛药数天以上的制剂。本文回顾了KADIAN，并从早期药代动力学和药效学研究、近期与酒精的药代动力学相互作用数据以及近期治疗非恶性疼痛的试验结果中确定了其独特特征。
