Brogan Shane E, Winter Natalie B, Okifuji Akiko
From the *Department of Anesthesiology, Huntsman Cancer Institute, and †Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT.
Reg Anesth Pain Med. 2015 Jul-Aug;40(4):369-75. doi: 10.1097/AAP.0000000000000251.
Although data exist for the efficacy of intrathecal therapy (ITT), there are no prospective data on patient-controlled intrathecal analgesia (PCIA) in refractory cancer pain. This study examines the effect of PCIA on cancer symptom scores, patient satisfaction, and analgesic efficacy with an emphasis on breakthrough pain (BTP).
Ninety-eight patients with refractory cancer pain prospectively completed questionnaires including the MD Anderson Symptom Inventory and a BTP survey before and after the implantation of an intrathecal pump.
Fifty-eight patients were included in the study group. Average "worst" pain scores decreased from 8.32 (SD, 1.73) pre-ITT to 4.98 (SD, 2.92) post-ITT, P < 0.001. Severe pain (numerical rating score ≥7) decreased from 84.2% to 35.2% (P < 0.001). Mean daily morphine equivalent dosing decreased from 805.3 mg/d to 128.2 mg/d, with 65.5% of patients discontinuing all nonintrathecal opioids. The mean MD Anderson Symptom Inventory symptom severity score decreased from 4.98 to 3.72 (P < 0.0001), and the symptom interference score from 6.53 to 4.37 (P < 0.001). Pain reduction was 46.8% with pre-ITT breakthrough medications and 65.2% with PCIA (P < 0.001). Median time to onset was 30 minutes with pre-ITT breakthrough medications and 10 minutes with PCIA (P < 0.001). Patient-controlled intrathecal analgesia, compared with conventional BTP medications, was "a lot better" in 60.7% and "a little better" in 28.6%. Overall pain control satisfaction was also improved, with 78.2% "a lot better" and 10.9% "I have no pain."
In patients with poorly controlled cancer pain, PCIA is associated with improved pain control, improved cancer-related symptoms, and high satisfaction. Compared with conventional BTP regimens, PCIA provides superior analgesia and a 3-fold faster onset of action.
尽管已有鞘内治疗（ITT）疗效的数据，但关于难治性癌痛患者自控鞘内镇痛（PCIA）尚无前瞻性数据。本研究探讨PCIA对癌症症状评分、患者满意度及镇痛效果的影响，重点关注爆发痛（BTP）。
98例难治性癌痛患者前瞻性地完成了问卷调查，包括MD安德森症状量表及鞘内泵植入前后的BTP调查。
58例患者纳入研究组。ITT前平均“最严重”疼痛评分从8.32（标准差1.73）降至ITT后4.98（标准差2.92），P<0.001。重度疼痛（数字评分量表≥7）从84.2%降至35.2%（P<0.001）。平均每日吗啡当量剂量从805.3mg/d降至128.2mg/d，65.5%的患者停用了所有非鞘内阿片类药物。MD安德森症状量表症状严重程度评分从4.98降至3.72（P<0.0001），症状干扰评分从6.53降至4.37（P<0.001）。ITT前爆发痛药物镇痛有效率为46.8%，PCIA为65.2%（P<0.001）。ITT前爆发痛药物起效中位时间为30分钟，PCIA为10分钟（P<0.001）。与传统BTP药物相比，60.7%的患者认为PCIA“好很多”，28.6%的患者认为“稍好一些”。总体疼痛控制满意度也有所提高，78.2%的患者认为“好很多”，10.9%的患者表示“无痛”。
在癌痛控制不佳的患者中，PCIA与更好的疼痛控制、改善癌症相关症状及高满意度相关。与传统BTP方案相比，PCIA镇痛效果更佳，起效快3倍。
