Shaheen Philip E, Walsh Declan, Lasheen Wael, Davis Mellar P, Lagman Ruth L
The Harry R Horvitz Center for Palliative Medicine, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center Institute, Cleveland, OH 44195, USA.
J Pain Symptom Manage. 2009 Sep;38(3):409-17. doi: 10.1016/j.jpainsymman.2009.06.004.
Pain is one of the most common symptoms in cancer patients. Opioids are widely prescribed for this and other purposes. Properly used, they are safe, but they have serious and potentially lethal side effects. Successful use of opioids to manage cancer pain requires adequate knowledge about opioid pharmacology and equianalgesia for the purpose of both drug rotation and route conversion. The aim of this study was to demonstrate variations in equianalgesic ratios, as quoted in equianalgesic tables and various educational materials widely available to practicing physicians. We surveyed commercially available educational materials in package inserts, teaching materials provided by pharmaceutical companies, and the Physicians' Desk Reference for equianalgesic tables of commonly used opioids. We found inconsistent and variable equianalgesic ratios recommended for both opioid rotation and conversion. Multiple factors like inter- and intraindividual differences in opioid pharmacology may influence the accuracy of dose calculations, as does the heterogeneity of study design used to derive equianalgesic ratios. Equianalgesic tables should only serve as a general guideline to estimate equivalent opioid doses. Clinical judgment should be used and individual patient characteristics considered when applying any table. Professional organizations and regulators should establish a rotation and conversion consensus concerning opioid equianalgesic ratios. Systematic research on equianalgesic opioid dose calculation is recommended to avoid adverse public health consequences of incorrect or inappropriate dosing. Current information in equianalgesic tables is confusing for physicians, and dangerous to the public.
疼痛是癌症患者最常见的症状之一。阿片类药物因这一症状及其他用途而被广泛处方。正确使用时，它们是安全的，但会产生严重且可能致命的副作用。成功使用阿片类药物来控制癌症疼痛需要充分了解阿片类药物药理学以及等效镇痛，以便进行药物轮换和给药途径转换。本研究的目的是证明等效镇痛比的差异，这些差异在等效镇痛表以及执业医师广泛可获取的各种教育材料中有所体现。我们调查了药品说明书中的市售教育材料、制药公司提供的教材以及《医师案头参考》中常用阿片类药物的等效镇痛表。我们发现，对于阿片类药物的轮换和转换，所推荐的等效镇痛比不一致且存在变数。阿片类药物药理学中的个体间和个体内差异等多种因素可能会影响剂量计算的准确性，用于得出等效镇痛比的研究设计的异质性也会产生影响。等效镇痛表仅应作为估算等效阿片类药物剂量的一般指南。应用任何表格时都应运用临床判断力并考虑患者的个体特征。专业组织和监管机构应就阿片类药物等效镇痛比建立轮换和转换共识。建议对等效镇痛阿片类药物剂量计算进行系统研究，以避免因不正确或不恰当给药而产生不良公共卫生后果。等效镇痛表中的当前信息让医生感到困惑，对公众也很危险。
