Department of Psychiatry, University of California, San Diego, San Diego, USA.
Support Care Cancer. 2011 Dec;19(12):2015-20. doi: 10.1007/s00520-010-1052-1. Epub 2010 Nov 30.
Patients with malignancy sometimes develop painful mucositis and require patient-controlled analgesia (PCA) to treat their pain. Pain disrupts sleep and there is some evidence that analgesic medications also disrupt sleep. This study examined whether treatment with the sedative hypnotic eszopiclone could improve self-reports of sleep, fatigue, and pain as well as decrease opioid self-administered via PCA.
Inpatients who developed mucositis severe enough to require PCA treatment were randomized double-blind to a 2-day trial on eszopiclone or placebo-administered at bedtime. Patients completed questionnaires which assessed sleep, pain, and fatigue. PCA medication was calculated in terms of morphine equivalents. Data were analyzed with unpaired t tests and repeated measures analysis of variance.
Twenty-two patients were randomized to placebo and 23 to eszopiclone. Groups were comparable in age and treatment characteristics. Mean pain scores were lower in the eszopiclone group at all time points (morning p = 0.01, afternoon p = 0.04, evening p = 0.04). The eszopiclone group reported increased sleep time (p < 0.05), fewer nighttime awakenings (p < 0.001), better self-reported sleep quality (p = 0.01), and depth (p = 0.04). There were no significant differences between eszopiclone and placebo in terms of self-reports of fatigue or opioid usage.
Sedative hypnotic agents improve sleep and analgesia even in the setting of considerable pain and discomfort.
患有恶性肿瘤的患者有时会出现疼痛性黏膜炎，并需要患者自控镇痛（PCA）来治疗疼痛。疼痛会扰乱睡眠，并且有一些证据表明镇痛药物也会扰乱睡眠。本研究旨在探讨镇静催眠药右佐匹克隆是否可以改善睡眠、疲劳和疼痛的自我报告，以及减少通过 PCA 自我给予的阿片类药物。
因黏膜炎严重需要 PCA 治疗而住院的患者被随机双盲分为右佐匹克隆或安慰剂组，在睡前给药，进行为期 2 天的试验。患者完成了评估睡眠、疼痛和疲劳的问卷。PCA 药物以吗啡当量计算。数据采用配对 t 检验和重复测量方差分析进行分析。
22 例患者被随机分配至安慰剂组，23 例患者被随机分配至右佐匹克隆组。两组在年龄和治疗特征方面具有可比性。右佐匹克隆组在所有时间点的平均疼痛评分均较低（早晨 p = 0.01，下午 p = 0.04，晚上 p = 0.04）。右佐匹克隆组报告睡眠时间增加（p < 0.05），夜间觉醒次数减少（p < 0.001），自我报告睡眠质量（p = 0.01）和深度（p = 0.04）更好。右佐匹克隆组与安慰剂组在自我报告的疲劳或阿片类药物使用方面无显著差异。
镇静催眠药可改善睡眠和镇痛，即使在疼痛和不适较为严重的情况下也是如此。
