Faculty of Health, Birmingham City University, Birmingham, UK.
Pain Physician. 2012 Sep-Oct;15(5):363-9.
Tolerance is defined as a phenomenon in which exposure to a drug results in a decrease of an effect or the requirement of a higher dose to maintain an effect. The fear of a patient developing opioid tolerance contributes regularly to the stigmatization and withholding of intrathecal opioid therapy for chronic pain of non-cancer origin.
The aim of this study was to describe the intrathecal opioid dose escalation throughout the years in chronic non-cancer pain patients. A secondary objective was the development of an intrathecal opioid dose predictive model.
Retrospective assessment of medical records.
Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom.
Medical records were reviewed and pump refill notes screened from the date of implant through November 2010 for 31 patients undertaking continuous intrathecal opioid therapy. All the patients included had undertaken a minimum of 6 years of intrathecal therapy when the data were collected.
Significant increases in the intrathecal morphine dose were verified between follow-up at one year and all subsequent observations, F (2.075, 62.238) = 13.858, 0 < 0.001, but ceased to be significant from year 3 onwards, indicating stability of the morphine dose, F (3, 90) = 2.516, P = 0.63. A model that accounts for 76% of the variability of morphine doses at year 6 based on year 2 assessment combined with duration of pain prior to initiation of intrathecal therapy was developed: year 6 dose = -0.509 + (1.296 x [year 2 dose]) + (0.061 x [duration of pain]).
Retrospective study.
The opioid dose escalation observed throughout the years was modest and not significant following year 3 of therapy. The model developed has the potential to assist the physician in the identification of a need for alternative treatment strategies. Furthermore, since many of the pump replacements are performed prior to year 6, it can also assist in the informed decision of the benefits and risks of the maintenance of this therapy.
耐受是指药物暴露导致效应降低或需要更高剂量维持效应的现象。由于担心患者产生阿片类药物耐受，经常导致椎管内阿片类药物治疗慢性非癌性疼痛的污名化和被拒绝。
本研究旨在描述慢性非癌性疼痛患者多年来椎管内阿片类药物剂量的递增情况。次要目的是建立一个椎管内阿片类药物剂量预测模型。
回顾性评估病历。
英国达德利拉塞尔大厅医院疼痛管理科。
从植入日期到 2010 年 11 月，对 31 名接受持续椎管内阿片类药物治疗的患者的泵再填充记录进行了病历审查和筛查。所有纳入的患者在收集数据时至少接受了 6 年的椎管内治疗。
在一年的随访和所有后续观察中，证实了椎管内吗啡剂量的显著增加，F（2.075，62.238）= 13.858，0 < 0.001，但从第 3 年开始不再显著，表明吗啡剂量的稳定性，F（3，90）= 2.516，P = 0.63。基于第 2 年评估，结合开始椎管内治疗前疼痛持续时间，建立了一个可解释第 6 年吗啡剂量 76%的变异性的模型：第 6 年剂量= -0.509 +（1.296 x [第 2 年剂量]）+（0.061 x [疼痛持续时间]）。
回顾性研究。
在治疗的第 3 年之后，观察到的阿片类药物剂量递增是适度的，没有显著意义。所建立的模型有可能协助医生确定是否需要替代治疗策略。此外，由于许多泵更换都是在第 6 年之前进行的，它还可以协助医生在知情的情况下决定维持这种治疗的益处和风险。
Zotero 插件