影响阿片类药物治疗爆发性癌痛的因素：IOPS-MS 研究的二次分析。
Factors influencing the use of opioids for breakthrough cancer pain: A secondary analysis of the IOPS-MS study.
机构信息
Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy.
Department of Supportive/Palliative Care, MD Anderson, Houston, Texas.
出版信息
Eur J Pain. 2019 Apr;23(4):719-726. doi: 10.1002/ejp.1339. Epub 2018 Dec 28.
BACKGROUND
Controversies exist about the choice and the doses of opioid medication in breakthrough cancer pain (BTcP).
METHODS
The aim was to assess factors influencing the use and the doses of opioids prescribed for BTcP. There was performed a secondary analysis of a national, multicentre study that involving 32 centres performed in patients having BTcP. Diagnosis of BTcP was based on a definite algorithm. Patients using opioids for background pain and for BTcP were selected. Average pain intensity and opioids used for background pain and BTcP, and adverse effects were assessed, as well as patient's satisfaction and the grade of mucositis.
RESULTS
The analysis was performed in 2,771 patients. Opioid doses given for BTcP were significantly associated with those given for background pain. No relationship between adverse effects and the use and the doses of opioids used for BTcP was found. Drugs and doses were not correlated to the grade of oral mucositis. Nasal fentanyl preparations provided the fastest meaningful pain relief in comparison with other fentanyl transmucosal preparations or morphine preparations (P = 0.000). The majority of patients were satisfied with opioid medications given for BTcP. Only 2.8% of patients reported adverse effects related to opioid medication used for BTcP. Age and gender were independently associated with dosages of some fentanyl products.
CONCLUSIONS
Opioids for BTcP were effective and safe in a large sample of cancer patients with different stages of disease. Doses of opioids proportional to doses used for background pain seem to guarantee both efficacy and safety.
SIGNIFICANCE
The use of opioids for breakthough cancer pain was effective and safe in a large sample of advanced cancer patients recruited in different stages of disease and settings. Doses of opioids proportional to opioid doses used for background analgesia, seem to guarantee both effectiveness and safety.
背景
在突破性癌症疼痛（BTcP）中，阿片类药物的选择和剂量存在争议。
方法
本研究旨在评估影响 BTcP 中阿片类药物使用和剂量的因素。对涉及 32 个中心的全国性多中心研究进行了二次分析，该研究纳入了 BTcP 患者。BTcP 的诊断基于明确的算法。选择了正在使用阿片类药物治疗背景疼痛和 BTcP 的患者。评估了平均疼痛强度和用于背景疼痛和 BTcP 的阿片类药物以及不良反应，以及患者的满意度和口腔粘膜炎程度。
结果
对 2771 例患者进行了分析。BTcP 中给予的阿片类药物剂量与用于背景疼痛的剂量显著相关。未发现不良反应与 BTcP 中阿片类药物的使用和剂量之间存在关系。药物和剂量与口腔粘膜炎程度无关。与其他芬太尼经粘膜制剂或吗啡制剂相比，鼻腔芬太尼制剂在提供快速有效的疼痛缓解方面具有优势（P = 0.000）。大多数患者对 BTcP 中给予的阿片类药物满意。只有 2.8%的患者报告了与 BTcP 中使用的阿片类药物相关的不良反应。年龄和性别与某些芬太尼产品的剂量独立相关。
结论
在不同疾病阶段的大量癌症患者中，BTcP 的阿片类药物是有效且安全的。与用于背景疼痛的剂量成比例的阿片类药物剂量似乎既能保证疗效又能保证安全性。
意义
在不同疾病阶段和不同环境中招募的大量晚期癌症患者中，BTcP 中使用阿片类药物是有效且安全的。与用于背景镇痛的阿片类药物剂量成比例的阿片类药物剂量似乎既能保证疗效又能保证安全性。
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