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老年疼痛和姑息治疗患者使用屈大麻酚:法定医疗保险覆盖的门诊医疗回顾性评估

[Dronabinol in geriatric pain and palliative care patients : A retrospective evaluation of statutory-health-insurance-covered outpatient medical treatment].

作者信息

Wendelmuth Christoph, Wirz Stefan, Torontali Misel, Gastmeier Anne, Gastmeier Knud

机构信息

Zentrum für ambulantes Operieren, Spezielle Schmerztherapie und Palliativmedizin, Praxis Gastmeier, Karl-Marx-Str. 42, 14482, Potsdam, Deutschland.

Abteilung für Anästhesie, Intensiv‑, Schmerz- und Palliativmedizin; Zentrum für Schmerzmedizin; Weaningzentrum, GFO-Kliniken Bonn, Cura Bad Honnef, Schülgenstraße 15, 53604, Bad Honnef, Deutschland.

出版信息

Schmerz. 2019 Oct;33(5):384-391. doi: 10.1007/s00482-019-00408-1.

Abstract

BACKGROUND

Geriatric patients often suffer from a long history of pain and have a limited life expectancy. Cannabinoid receptor agonists like dronabinol may be an effective, low-risk treatment option for geriatric patients with chronic pain.

OBJECTIVES

The effectiveness and side effects of dronabinol therapy in geriatric patients are analyzed. The effects of the approval requirement are presented.

METHODS

In our retrospective monocentric cohort study, the study population comprised all geriatric patients over the age of 80 years who were treated in our office since the cannabis law came into effect on 10 March 2017 until 17 July 2018 (evaluation date). Geriatric, nonpalliative pain patients (group A) and geriatric palliative patients (group B) were investigated. The basis of the evaluation was a questionnaire sheet that we use in our office with details of dosages, pain intensity, treatment effects and side effects from dronabinol therapy.

RESULTS

By using dronabinol, 21 of the 40 geriatric patients (52.5%) achieved pain relief of more than 30%, 10% of the patients of more than 50%. On average, about four symptoms or side effects related to previous treatment were positively influenced. 26% of patients reported side effects. The rejection rates on the part of the health insurances were 38.7% (group A) and 10.3% (group B).

CONCLUSIONS

This study is one of the few analyses of the use of Dronabinol in geriatric patients. We show that cannabis-based drugs (in this case dronabinol) are an effective, low-risk treatment option that should be considered early in therapy. Regarding the indication spectrum, further clinical studies and an approval-free test phase are necessary.

摘要

背景

老年患者常伴有长期疼痛病史且预期寿命有限。像屈大麻酚这样的大麻素受体激动剂可能是老年慢性疼痛患者一种有效的低风险治疗选择。

目的

分析屈大麻酚治疗老年患者的有效性和副作用。介绍批准要求的影响。

方法

在我们的回顾性单中心队列研究中,研究人群包括自2017年3月10日大麻法律生效至2018年7月17日(评估日期)在我们科室接受治疗的所有80岁以上老年患者。对老年非姑息性疼痛患者(A组)和老年姑息性患者(B组)进行了调查。评估依据是我们科室使用的一份问卷,其中包含屈大麻酚治疗的剂量细节、疼痛强度、治疗效果和副作用。

结果

使用屈大麻酚后,40名老年患者中有21名(52.5%)疼痛缓解超过30%,10%的患者疼痛缓解超过50%。平均而言,约四种与先前治疗相关的症状或副作用得到了积极改善。26%的患者报告有副作用。医疗保险的拒付率分别为38.7%(A组)和10.3%(B组)。

结论

本研究是为数不多的关于屈大麻酚在老年患者中应用的分析之一。我们表明,基于大麻的药物(在本案例中为屈大麻酚)是一种有效的低风险治疗选择,应在治疗早期予以考虑。关于适应证范围,有必要进行进一步的临床研究和免批准试验阶段。

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