University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Anaesthesiology and Pain Management, OLVG, Amsterdam, The Netherlands.
University Pain Centre Maastricht (UPCM), Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.
Eur J Cancer. 2016 Sep;65:121-9. doi: 10.1016/j.ejca.2016.06.025. Epub 2016 Aug 3.
Cancer pain is still inadequately treated in up to 60% of cancer patients. Based on the additional effect on the N-Methyl-d-Aspartate receptor, we expected that methadone (Met) could provide better pain relief than fentanyl (Fen) in cancer pain with a neuropathic pain component.
A randomised controlled trial was performed with 52 strong opioids naive patients with head-and-neck cancer with substantial pain (pain Numerical Rating Scale [NRS] > 4) and a neuropathic pain component (Douleur Neuropathique [DN4] > 4). Twenty-six patients were treated with Met and 26 with Fen. Patients were evaluated at 1, 3 and 5 weeks. The primary outcomes were reduction in average pain, clinical success (defined as 50% average pain decrease) and reduction in pain interference. Secondary outcomes were global perceived effect (GPE) and side-effects.
Reduction in NRS was higher with the use of Met at 1, 3 and 5 weeks (pain change 2.9, 3.1 and 3.1) compared to Fen (1.4, 1.7 and 2.0). This difference was significant at 1 (p = 0.011) and at 3 weeks (p = 0.03). Clinical success (>50% improvement) was higher with Met at 1 week (15% versus 50%, p = 0.012). The change in pain interference, the GPE and side-effect profile were not significantly different between the groups.
This is the first study to compare the effects of Met to Fen in cancer patients with a neuropathic pain component. Based on the results of this study, Met should be considered in the treatment of oncological pain with a neuropathic component.
多达 60%的癌症患者的癌痛仍未得到充分治疗。基于对 N-甲基-D-天冬氨酸受体的附加作用，我们预计美沙酮（Met）在伴有神经病理性疼痛成分的癌痛中比芬太尼（Fen）能提供更好的疼痛缓解。
一项随机对照试验纳入了 52 例头颈部癌症且疼痛明显（疼痛数字评分量表[NRS] > 4）且有神经病理性疼痛成分（DN4 > 4）的强阿片类药物初治患者。26 例患者接受 Met 治疗，26 例患者接受 Fen 治疗。患者在第 1、3 和 5 周进行评估。主要结局为平均疼痛缓解、临床疗效（定义为平均疼痛减轻 50%）和疼痛干扰减少。次要结局为总体感知效果（GPE）和副作用。
Met 在第 1、3 和 5 周时的 NRS 降低更高（疼痛变化分别为 2.9、3.1 和 3.1），而 Fen 则为 1.4、1.7 和 2.0，在第 1 周（p = 0.011）和第 3 周（p = 0.03）差异具有统计学意义。Met 在第 1 周的临床疗效（改善> 50%）更高（15%比 50%，p = 0.012）。疼痛干扰、GPE 和副作用的变化在两组之间没有显著差异。
这是第一项比较美沙酮和芬太尼在伴有神经病理性疼痛成分的癌症患者中的效果的研究。基于这项研究的结果，美沙酮应该被考虑用于治疗伴有神经病理性成分的癌痛。
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