Sarma Riniki, Sirohiya Prashant, Ratre Brajesh Kumar, Bhatnagar Sushma
Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA IRCH, AIIMS, New Delhi, India.
Department of Anaesthesia, ABVIMS and Dr. RML Hospital, New Delhi, India.
Indian J Palliat Care. 2020 Oct-Dec;26(4):495-499. doi: 10.4103/IJPC.IJPC_9_20. Epub 2020 Nov 19.
Palliative care physicians in India have achieved access to methadone for pain relief in cancer patients. Despite being an effective drug in terms of analgesia, there are a number of reasons why this opioid medication is not as much as popular as morphine. We identified and tried to overcome a few such barriers in treating cancer pain with methadone.
The clinical information of ten adult cancer patients (six males and four females), who voluntarily received methadone for their severe pain in the month of August 2019 were analysed retrospectively. We converted morphine to methadone in all ten patients under the supervision of an experienced practitioner.
During the methadone therapy, eight out of ten patients who were given methadone exclusively for their pain had adequate pain relief initially. The barriers identified included difficult titration methods due to distinct pharmacology, patient selection, clinical inertia, communication and co-ordination among physicians, communication among patient and physician, and patient and caregivers, and vigilant monitoring.
Methadone is still finding its place in India for cancer pain management. As the drug is new to Indian practitioners, we have to overcome these barriers and facilitate its judicious use in cancer pain management.
印度的姑息治疗医生已能为癌症患者获取美沙酮用于止痛。尽管就镇痛而言它是一种有效药物，但这种阿片类药物不如吗啡受欢迎，原因有很多。我们确定并试图克服在用美沙酮治疗癌症疼痛时的一些此类障碍。
回顾性分析了2019年8月自愿接受美沙酮治疗重度疼痛的10例成年癌症患者（6例男性和4例女性）的临床信息。在一名经验丰富的医生的监督下，我们对所有10例患者进行了吗啡向美沙酮的转换。
在美沙酮治疗期间，仅因疼痛接受美沙酮治疗的10例患者中有8例最初疼痛得到了充分缓解。确定的障碍包括由于独特的药理学导致的滴定方法困难、患者选择、临床惰性、医生之间的沟通与协调、患者与医生之间以及患者与护理人员之间的沟通，以及密切监测。
在印度，美沙酮在癌症疼痛管理中仍在寻找其位置。由于这种药物对印度医生来说是新的，我们必须克服这些障碍，并促进其在癌症疼痛管理中的明智使用。
