Husic Samir, Imamovic Semir, Matic Srecko, Sukalo Aziz
Center for Palliative Care, Univerzity Clinical Center Tuzla, Bosnia and Herzegovina.
Clinic for anesthesia and reanimation, Univerzity Clinical Center Tuzla, Bosnia and Herzegovina.
Med Arch. 2017 Aug;71(4):246-250. doi: 10.5455/medarh.2017.71.246-250.
This research was to follow characteristics of breakthrough pain caused by cancer (BTcP) and other most common sympthoms (ESAS) at patients in advanced stage of cancer disease in palliative care.
Prospective study included 433 patients which were treated in Palliative Care Centre in UKC Tuzla, Bosnia and Herzegovina. Group 1 was consisted of 353 patients whose basal cancer pain of intensity 4-7 NRS was treated weak opiates (basal analgetic- fixed combination of tramadol/paracetamol (37.5 mg/325 mg) in initial dose 3x1tbl for pain intensity 4, to 4x2tbl (for pain intensity 7). In Group 2 (80 patients) basal pain of intensity 8-10 was treated strong opiates as basal analgetic (oral morphine and transdermal fentanil). If the previous day were 2 or more breakthrough pain that required ''rescue dose'' of analgetics (tramadol 50-100 mg orally in group 1 ie. Oral morphine 8-12 mg in the group 2), the dose of basal analgetic was increased.
The total number of reported breakthrough pain in all 433 patients for 10 days of treatment was 3 369 (0.78 BTcP /per patient/day), where at Group 1 patients showed significantly lower BTcP (0.56 BTcP/patient/day). The average intensity of BTcP was 5.91 where in the Group1 was 4.51 while in the Group 2 8.04. 582 (17.28%) was rated grade 7, of which 539 were successfully coupled by strong and 43 (7.39%) successfully coupled by weak opiates. From 556 BTcP who were rated with 8, 540 of them were coupled strong and only 16 successfully coupled by weak opiates. 1967 (58.39 %) of breakthrough pain has occured in the evening hours (18-06 h), while 1402 (41.62%) BTCP occured during day hours (06-18h). Most (1290 or 38.29%) of breakthrough pain lasted less than 10 minutes, 882 (26.18%) between 16 and 20 minutes, 752 (22.32%) between 11 and 15 minutes, 407 (12.8%) between 21 and 30 minutes and 38 (1.13%) lasted longer than 20 minutes.
Duriong our study, we noted a relatively large number of breakthrough pain with lower intensity (3-6) in patients treated with weak opiates, which are also adversely affected patients satisfaction with pain treatment and required additional doses of analgetics. In the small percentage is possible the breakthrough pain of stronger intensity (7-8) treat by maximum doses of weak opiates.
本研究旨在追踪癌症所致爆发性疼痛（BTcP）的特征以及姑息治疗中晚期癌症患者的其他最常见症状（ESAS）。
前瞻性研究纳入了在波斯尼亚和黑塞哥维那图兹拉大学临床中心姑息治疗中心接受治疗的433例患者。第1组由353例患者组成，其基础癌痛强度为4 - 7 NRS，使用弱阿片类药物治疗（基础镇痛药——曲马多/对乙酰氨基酚固定复方制剂（37.5毫克/325毫克），疼痛强度为4时初始剂量为每日3次，每次1片，疼痛强度为7时剂量增至每日4次，每次2片）。第2组（80例患者）基础疼痛强度为8 - 10，使用强阿片类药物作为基础镇痛药（口服吗啡和透皮芬太尼）。如果前一天出现2次或更多需要“解救剂量”镇痛药的爆发性疼痛（第1组口服曲马多50 - 100毫克，第2组口服吗啡8 - 12毫克），则增加基础镇痛药的剂量。
在为期10天的治疗中，433例患者报告的爆发性疼痛总数为3369次（0.78次BTcP/患者/天），其中第1组患者的BTcP显著更低（0.56次BTcP/患者/天）。BTcP的平均强度为5.91，第1组为4.51，第2组为8.04。582次（17.28%）疼痛评分为7级，其中539次通过强阿片类药物成功控制，43次（7.39%）通过弱阿片类药物成功控制。在556次评分为8级的BTcP中，540次通过强阿片类药物控制，仅16次通过弱阿片类药物成功控制。1967次（58.39%）爆发性疼痛发生在夜间（18 - 06时），而1（41.62%）BTCP发生在白天（06 - 18时）。大多数（1290次或38.29%）爆发性疼痛持续时间少于10分钟，882次（26.18%）持续16至20分钟，752次（22.32%）持续11至15分钟，407次（12.8%）持续21至30分钟，38次（1.13%）持续时间超过20分钟。
在我们的研究中，我们注意到使用弱阿片类药物治疗的患者中爆发性疼痛强度较低（3 - 6）的情况相对较多，这也对患者对疼痛治疗的满意度产生了不利影响，并且需要额外剂量的镇痛药。在小部分情况下，最大剂量的弱阿片类药物有可能控制强度更强（7 - 8）的爆发性疼痛。
