Madden Kevin, Haider Ali, Rozman De Moraes Aline, Naqvi Syed Mujtaba, Enriquez Parema Alizadeh, Wu Jimin, Williams Janet, Liu Diane, Bruera Eduardo
M.D. Anderson Cancer Center, University of Texas, Houston, Texas, USA.
Department of Palliative, Rehabilitation and Integrative Medicine, Houston, Texas, USA.
J Palliat Med. 2021 Jan;24(1):91-96. doi: 10.1089/jpm.2019.0614. Epub 2020 Jun 2.
Patients with cancer-related pain use opioids for nociceptive pain, while gabapentinoids are common to treat neuropathic pain. The simultaneous use of opioids with gabapentinoids has been associated with an increased risk of opioid-related death. Determine the frequency of combined use of gabapentinoids among patients receiving opioids for cancer-related pain. We also examined if concomitant use of opioids and gabapentinoids together was associated with increased scores of fatigue and drowsiness on the Edmonton Symptom Assessment Scale (ESAS) compared to patients on opioids. Retrospective study of patients on opioids and opioids plus gabapentinoids at their third visit to the outpatient Supportive Care Center. We found that 48% (508/1059) of patients were on opioids. Of these patients, 51% (257/508) were on opioids only, and 49% (251/508) were on opioids plus gabapentinoids. The median (interquartile range [IQR]) morphine equivalent daily dose for patients on opioids was 75 (45, 138) mg, and opioids plus gabapentinoids was 68 (38, 150) mg ( = 0.94). The median (IQR) gabapentinoid equivalent daily dose was 900 (300, 1200) mg. The median (IQR) for ESAS-fatigue in patients on opioids was 5 (3, 7), and opioids plus gabapentinoids was 5 (3, 7) ( = 0.27). The median (IQR) for ESAS-drowsiness in patients on opioids was 3 (0, 5), and opioids plus gabapentinoids was 3 (0, 6) ( = 0.11). Almost 50% of advanced cancer patients receiving opioids for pain were exposed to gabapentinoids. Maximal efforts should be made to minimize potential complications from the concomitant use of opioids with gabapentinoids.
患有癌症相关疼痛的患者使用阿片类药物治疗伤害性疼痛，而加巴喷丁类药物常用于治疗神经性疼痛。同时使用阿片类药物和加巴喷丁类药物与阿片类药物相关死亡风险增加有关。确定在接受阿片类药物治疗癌症相关疼痛的患者中加巴喷丁类药物联合使用的频率。我们还研究了与仅使用阿片类药物的患者相比，同时使用阿片类药物和加巴喷丁类药物是否与埃德蒙顿症状评估量表（ESAS）上的疲劳和嗜睡评分增加有关。对在门诊支持性护理中心第三次就诊时使用阿片类药物以及使用阿片类药物加加巴喷丁类药物的患者进行回顾性研究。我们发现48%（508/1059）的患者使用阿片类药物。在这些患者中，51%（257/508）仅使用阿片类药物，49%（251/508）使用阿片类药物加加巴喷丁类药物。使用阿片类药物的患者每日吗啡当量中位数（四分位间距[IQR]）为75（45，138）mg，使用阿片类药物加加巴喷丁类药物的患者为68（38，150）mg（P = 0.94）。加巴喷丁类药物每日当量中位数（IQR）为900（300，1200）mg。使用阿片类药物的患者ESAS-疲劳中位数（IQR）为5（3，7），使用阿片类药物加加巴喷丁类药物的患者为5（3，7）（P = 0.27）。使用阿片类药物的患者ESAS-嗜睡中位数（IQR）为3（0，5），使用阿片类药物加加巴喷丁类药物的患者为3（0，6）（P = 0.11）。近50%接受阿片类药物治疗疼痛的晚期癌症患者使用了加巴喷丁类药物。应尽最大努力将阿片类药物与加巴喷丁类药物同时使用的潜在并发症降至最低。
