Portenoy Russell K, Foley Kathleen M
Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, and Department of Neurology, Cornell University Medical College, New York, NY 10021 U.S.A.
Pain. 1986 May;25(2):171-186. doi: 10.1016/0304-3959(86)90091-6.
Thirty-eight patients maintained on opioid analgesics for non-malignant pain were retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene, meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for pain management while receiving therapy. Few substantial gains in employment or social function could be attributed to the institution of opioid therapy. No toxicity was reported and management became a problem in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics, including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social variables capable of explaining the success of long-term management. We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.
对38例使用阿片类镇痛药治疗非恶性疼痛的患者进行回顾性评估，以确定该疗法的适应症、疗程、安全性和有效性。12例患者使用羟考酮，7例使用美沙酮，5例使用左啡诺；其他患者使用丙氧芬、哌替啶、可待因、喷他佐辛或这些药物的某种组合进行治疗。19例患者在评估时接受治疗已达四年或更长时间，6例患者维持治疗超过七年。三分之二的患者每天所需吗啡当量低于20毫克，只有4例患者每天用量超过40毫克。患者偶尔需要增加剂量和/或因疼痛加剧而住院治疗；之后剂量通常会恢复到稳定的基线水平。24例患者表示疼痛得到部分但可接受或完全充分的缓解，而14例患者报告缓解不足。接受治疗期间，没有患者因疼痛管理而接受外科手术。很少有就业或社会功能的显著改善可归因于阿片类药物治疗的实施。未报告有中毒情况，仅2例有药物滥用史的患者出现了管理问题。对患者特征进行的严格审查，包括24例患者的16项人格因素问卷数据、23例患者的明尼苏达多相人格调查表数据以及6例患者的详细精神评估，均未发现能够解释长期治疗成功的心理或社会变量。我们得出结论，对于那些患有顽固性非恶性疼痛且无药物滥用史的患者，阿片类维持治疗可以是一种安全、有益且更人道的替代手术或不治疗的选择。
