Monterubbianesi Maria Cristina, Capuccini Jenny, Ferioli Isabella, Tassinari Davide, Sarti Donatella, Raffaeli William
Pain Therapy and Pallitive Care Unit, Infermi Hospital, Rimini, Italy.
J Opioid Manag. 2012 Sep-Oct;8(5):292-8. doi: 10.5055/jom.2012.0129.
Chronic opioid administration can induce adverse drug-dependent events and tolerance and/or hyperalgesia development. Opioid rotation is the treatment option in this case; however, it can expose patients to long periods of ineffectiveness and/or development of withdrawal syndrome, overdose, or adverse events. To overcome this issue, a method of rapid detoxification from opioids has been developed.
To assess feasibility and efficacy of our opioid detoxification protocol in patients affected from chronic cancer pain. SETTINGS/PATIENTS: We studied 15 patients, with chronic cancer pain, who were afferent to Hospice of Rimini, Italy, were in therapy with high doses of opioid and needed opioid rotation or a therapeutic variation because of opioid toxicity, inefficacy, tolerance, or hyperalgesia. Each patient received a fixed dose of endovenous morphine and clonidine plus oral ketoprofen or ibuprofen, and oral lorazepam, if required, for at least 3 days, suspending the previous opioid therapy. We monitored withdrawal symptoms, pain intensity, type, and intensity of adverse events.
Withdrawal symptoms were experienced by four (26.6 percent) patients. The average Numerical Rating Scale for pain decreased significantly (p < 0.05) from 8.3 ± 1.57 to 3.6 ± 1.4 at the end of the detoxification and to 2.4 ± 1 at the end of the rotation or therapeutic adjustment. Average duration of the detoxification was 6.86 ± 6.4 days (range 3-22).
The results suggested that the detoxification protocol may be effective in preventing withdrawal signs in patients needing a therapeutic change because of opioid-induced tolerance, hyperalgesia, or toxicity.
长期使用阿片类药物可引发药物依赖性不良事件以及耐受性和/或痛觉过敏。在这种情况下，阿片类药物轮换是一种治疗选择；然而，这可能会使患者长时间处于无效治疗状态，和/或出现戒断综合征、过量用药或不良事件。为克服这一问题，已开发出一种从阿片类药物快速脱毒的方法。
评估我们的阿片类药物脱毒方案对慢性癌痛患者的可行性和有效性。
设置/患者：我们研究了15例患有慢性癌痛的患者，这些患者入住意大利里米尼临终关怀院，正在接受高剂量阿片类药物治疗，因阿片类药物毒性、无效、耐受性或痛觉过敏而需要进行阿片类药物轮换或治疗调整。每位患者接受固定剂量的静脉注射吗啡和可乐定，外加口服酮洛芬或布洛芬，必要时口服劳拉西泮，至少持续3天，同时暂停先前的阿片类药物治疗。我们监测了戒断症状、疼痛强度、不良事件的类型和强度。
4名（26.6%）患者出现了戒断症状。脱毒结束时，疼痛的平均数字评分量表评分从8.3±1.57显著降至3.6±1.4（p<0.05），在轮换或治疗调整结束时降至2.4±1。脱毒的平均持续时间为6.86±6.4天（范围为3 - 22天）。
结果表明，该脱毒方案可能有效地预防因阿片类药物诱导的耐受性、痛觉过敏或毒性而需要治疗改变的患者出现戒断症状。
