Mercadante Sebastiano, Villari Patrizia, Ferrera Patrizia, Arcuri Edoardo, David Fabrizio
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo Colli 312, 90146 Palermo, Italy.
Clin J Pain. 2009 Sep;25(7):648-9. doi: 10.1097/AJP.0b013e3181a68a85.
To improve opioid repsonse in patients with movement-related pain by using opioid switching adding a burst of ketamine.
Two patients with incident bone pain who had adverse effects with increasing doses of opioids were switched to methadone and a burst of 100 mg/d of ketamine for 2 consecutive days was added.
Basal pain and pain on movement significantly improved.
The development of breakthrough pain due to movement (incident pain), associated with bone metastases is so rapid that no medication as needed has such a short onset to parallel this temporal pattern of pain firing. Experimental studies have shown that bone metastases are characterized by a specific pattern of spinal hyperexcitation requiring higher doses of opioids. Optimization of basal opioid regimen may improve mobilization. However, adverse effects may more likely occur. The role of opioid switching and burst ketamine to further improve the opioid response has never been assessed in this context. Further studies in animals could confirm these preliminary data, with specific design to parallel this clinical context.
通过使用阿片类药物转换并添加一次氯胺酮冲击疗法，改善与运动相关疼痛患者的阿片类药物反应。
两名因骨痛初发且随着阿片类药物剂量增加出现不良反应的患者，被转换为美沙酮治疗，并连续2天添加每日100毫克的氯胺酮冲击疗法。
基础疼痛和运动时疼痛显著改善。
与骨转移相关的因运动导致的突破性疼痛（偶发性疼痛）发展迅速，以至于按需用药没有如此短的起效时间来匹配这种疼痛发作的时间模式。实验研究表明，骨转移的特征是特定的脊髓过度兴奋模式，需要更高剂量的阿片类药物。优化基础阿片类药物治疗方案可能会改善活动能力。然而，不良反应可能更易发生。在这种情况下，阿片类药物转换和氯胺酮冲击疗法对进一步改善阿片类药物反应的作用从未得到评估。动物方面的进一步研究可以证实这些初步数据，采用特定设计以匹配这种临床情况。
