加巴喷丁在急症医院为接受专科姑息治疗的晚期癌症患者开具的处方。

Pregabalin prescription for terminally ill cancer patients receiving specialist palliative care in an acute hospital.

作者信息

Yajima Ryo, Matsumoto Kazuaki, Ise Yuya, Suzuki Norihito, Yokoyama Yuta, Kizu Junko, Katayama Shiro

机构信息

Section of Pharmaceutical Services, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 Japan ; Division of Practical Pharmacy, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan.

Division of Practical Pharmacy, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan.

出版信息

J Pharm Health Care Sci. 2016 Nov 5;2:29. doi: 10.1186/s40780-016-0063-6. eCollection 2016.

DOI:10.1186/s40780-016-0063-6

PMID:27826454

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5097839/

Abstract

BACKGROUND

Pregabalin is recommended as an adjuvant analgesic for neuropathic cancer-related pain, and may be taken at all steps of the World Health Organization analgesic ladder. However, unlike opioids, pregabalin treatments are limited to an oral administration route. If patients have oral feeding difficulties, it is not possible to administer any drug as an adjuvant analgesic for neuropathic cancer-related pain. Therefore, the aim of the present study was to clarify the problems of pain control after pregabalin discontinuation in terminally ill cancer patients.

METHODS

Our subjects comprised cancer patients who died during their hospital stay and were referred between April 2013 and October 2015 to the palliative care team of the 899-bed Cancer Hospital at the Nippon Medical School Hospital in Japan. The medical records of each patient were retrospectively reviewed, and patient characteristics were recorded.

RESULTS

We obtained data on 183 patients during the study period. Thirty-eight (20.8 %) patients were treated with pregabalin. Thirty-three (86.8 %) out of 38 patients were prescribed pregabalin for neuropathic cancer-related pain. The incidence of bony metastases was significantly higher in patients administered pregabalin than in those not taking the drug (non-pregabalin group 32.4 % vs pregabalin group 57.9 %). Pregabalin was ultimately discontinued in all patients, with the main reason being oral feeding difficulties (81.6 %). After the discontinuation of pregabalin, the amount of opioid drugs administered was increased in 56.5 % of patients with oral feeding difficulties.

CONCLUSION

Our results demonstrated that the amount of opioid drugs administered was increased in more than 50 % of patients following the discontinuation of pregabalin, and was repeatedly increased for some patients. A new administration route is required for cancer patients unable to take oral medication.

TRIAL REGISTRATION

UMIN000022507. May 28, 2016 retrospectively registered.

摘要

背景

普瑞巴林被推荐作为辅助镇痛药用于治疗与癌症相关的神经性疼痛，可在世界卫生组织镇痛阶梯的各个阶段使用。然而，与阿片类药物不同，普瑞巴林的治疗仅限于口服给药途径。如果患者存在经口进食困难，则无法给予任何药物作为与癌症相关的神经性疼痛的辅助镇痛药。因此，本研究的目的是阐明晚期癌症患者停用普瑞巴林后疼痛控制方面的问题。

方法

我们的研究对象为在住院期间死亡的癌症患者，这些患者于2013年4月至2015年10月被转诊至日本日本医科大学附属医院拥有899张床位的癌症医院的姑息治疗团队。对每位患者的病历进行回顾性审查，并记录患者特征。

结果

在研究期间，我们获取了183例患者的数据。38例（20.8%）患者接受了普瑞巴林治疗。38例患者中有33例（86.8%）因与癌症相关的神经性疼痛而开具普瑞巴林。接受普瑞巴林治疗的患者骨转移发生率显著高于未服用该药物的患者（非普瑞巴林组为32.4%，普瑞巴林组为57.9%）。所有患者最终均停用了普瑞巴林，主要原因是经口进食困难（81.6%）。在停用普瑞巴林后，5