Pain and Palliation Research Group, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
J Pain Symptom Manage. 2012 Apr;43(4):694-705. doi: 10.1016/j.jpainsymman.2011.05.008. Epub 2012 Jan 30.
The relationship between oxycodone and metabolite serum concentrations and clinical effects has not previously been investigated in cancer pain patients.
The aim of this study was to assess whether there is a relationship between oxycodone concentrations and pain intensity, cognitive functioning, nausea, or tiredness in cancer patients. Also, oxymorphone and noroxymorphone contributions to analgesia and the adverse effects of oxycodone were assessed.
Four hundred fifty-six cancer patients receiving oxycodone for cancer pain were included. Pain was assessed using the Brief Pain Inventory. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 was used to assess the symptoms of tiredness, nausea, constipation, and depression. Cognitive function was assessed using the Mini-Mental State Examination. Associations were examined by multiple linear or ordinal logistic regressions. Whether patients classified as being a "treatment success" or a "treatment failure" had different serum concentrations of oxycodone or metabolites was assessed using Mann-Whitney U-tests.
Serum concentrations of oxycodone and metabolites were not associated with pain intensity, nausea, tiredness, or cognitive function, with the exception that increased pain intensity was associated with higher oxymorphone concentrations. Patients with poor pain control and side effects had higher serum concentrations of the oxycodone metabolites, noroxycodone and noroxymorphone, compared with those with good pain relief and without side effects.
This study of patients receiving oxycodone for cancer pain confirms previous observations that there is most likely no association between serum concentrations of opioid analgesics and clinical effects.
阿片类药物奥施康定及其代谢物的血清浓度与临床疗效之间的关系尚未在癌症疼痛患者中进行过研究。
本研究旨在评估奥施康定浓度与癌症患者的疼痛强度、认知功能、恶心或疲劳之间是否存在关系。此外，还评估了羟吗啡酮和去甲羟吗啡酮对镇痛的贡献以及奥施康定的不良反应。
本研究纳入了 456 名接受奥施康定治疗癌症疼痛的癌症患者。疼痛通过简要疼痛量表进行评估。欧洲癌症研究与治疗组织生活质量问卷-C30 用于评估疲劳、恶心、便秘和抑郁症状。认知功能通过简易精神状态检查进行评估。采用多元线性或有序逻辑回归检验相关性。采用 Mann-Whitney U 检验评估被分类为“治疗成功”或“治疗失败”的患者的奥施康定或代谢物的血清浓度是否存在差异。
奥施康定及其代谢物的血清浓度与疼痛强度、恶心、疲劳或认知功能均无相关性，但疼痛强度增加与羟吗啡酮浓度升高有关。与疼痛缓解良好且无不良反应的患者相比，疼痛控制不佳和出现不良反应的患者的奥施康定代谢物，即去甲羟吗啡酮和去甲羟吗啡酮的血清浓度更高。
本项接受奥施康定治疗的癌症疼痛患者研究证实了之前的观察结果，即阿片类镇痛药物的血清浓度与临床疗效之间很可能不存在关联。
