National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Symptom Disorders, St. Olavs University Hospital, Trondheim, Norway.
Support Care Cancer. 2013 Jan;21(1):67-73. doi: 10.1007/s00520-012-1494-8. Epub 2012 Jun 1.
During opioid treatment of cancer pain, constipation is one of the most prevalent and bothersome side effects. Guidelines suggest that treatment with laxatives should be initiated when opioid therapy is started.
This study aims: (1) to determine to what extent patients, starting on opioids due to cancer pain, receive laxatives; (2) to examine the temporal relationship between initiation of opioid therapy and initiation of treatment with laxatives; and (3) to study to which extent the treatment follows current guidelines.
Data from the Norwegian prescription database (NorPD) were used to investigate dispensed prescriptions of laxatives to outpatients in Norway, who are receiving opioids for cancer pain. Data from NorPD cover all dispensed prescriptions of drugs to outpatients, making it possible to follow patients over time. The study cohort was followed from 2005 to the end of 2008.
Of 2,982 patients who started opioid therapy directly with WHO step III opioids, 1,325 patients (44.4 %) did not receive laxatives during the study period. Only 738 patients (24.7 %) received laxatives at the same time as opioid therapy was initiated. Another 657 patients (22.0 %) received laxatives after their initiation of opioids at some time during the study period.
Of those who started directly on a strong opioid, only one fourth received laxatives concomitantly with the first opioid, and nearly half did not receive laxatives at all. These findings indicate that the current guidelines are not followed.
在癌症疼痛的阿片类药物治疗中，便秘是最常见和最令人困扰的副作用之一。指南建议，在开始阿片类药物治疗时应开始使用泻药。
本研究旨在：（1）确定因癌症疼痛开始使用阿片类药物的患者接受泻药的程度；（2）研究开始阿片类药物治疗与开始使用泻药之间的时间关系；（3）研究治疗与当前指南的符合程度。
使用挪威处方数据库（NorPD）的数据来调查挪威接受阿片类药物治疗癌症疼痛的门诊患者的泻药配药情况。NorPD 数据涵盖了所有门诊患者的药物配药情况，因此可以对患者进行长期随访。研究队列从 2005 年随访至 2008 年底。
在直接开始使用世界卫生组织（WHO）第三阶梯阿片类药物的 2982 名患者中，有 1325 名患者（44.4%）在研究期间未接受泻药治疗。只有 738 名患者（24.7%）在开始阿片类药物治疗的同时接受了泻药治疗。另有 657 名患者（22.0%）在研究期间的某个时间开始使用阿片类药物后接受了泻药治疗。
直接开始使用强阿片类药物的患者中，只有四分之一的患者同时接受了泻药治疗，近一半的患者根本没有接受泻药治疗。这些发现表明，当前的指南并未得到遵循。
