Department of Palliative Medicine, Galway University Hospital, Saolta Hospitals Group, Galway, Ireland
Department of Palliative Medicine, Galway University Hospital, Saolta Hospitals Group, Galway, Ireland.
BMJ Support Palliat Care. 2024 Jan 8;13(e3):e839-e842. doi: 10.1136/spcare-2022-003586.
Emerging evidence suggests that methadone has a specific role in the management of treatment resistant cancer-related pain.
To investigate the utilisation pattern, safety and efficacy of methadone prescribed as an analgesic for the management of complex cancer-related pain in an acute hospital inpatient setting.
A retrospective longitudinal observational study of patients prescribed methadone as an analgesic between April 2020 and July 2021 was performed.Changes in coprescribed baseline opioid, use of breakthrough opioid analgesic, patient rated pain scores and adverse side effects were analysed.
16 patients with complex cancer-related treatment resistant pain who were prescribed methadone were included in the study. Of the 16 patients, 14 patients had metastatic disease. Pain was classified in 14 patients as mixed nociceptive-neuropathic and in 2 patients as neuropathic. 13 patients were coprescribed methadone with a pre-established opioid. Methadone was associated with a statistically significant decrease in both opioid breakthrough analgesic by 61%±28% (p<0.001), and coprescribed opioid by 17%±12% (p=0.015). Patient rated pain scores were also significantly decreased (p<0.001).
Methadone appears to have a specific role in the management of complex cancer pain, neuropathic pain, opioid-tolerance and opioid-induced hyperalgesia, which may be attributable to N-methyl-D-aspartate receptor antagonism.
新出现的证据表明，美沙酮在治疗耐药性癌症相关疼痛方面具有特定作用。
研究美沙酮作为一种镇痛药在急性住院患者中用于治疗复杂癌症相关疼痛的使用模式、安全性和疗效。
对 2020 年 4 月至 2021 年 7 月期间开具美沙酮作为镇痛药的患者进行回顾性纵向观察性研究。分析了基线阿片类药物共开处方、使用突破性阿片类镇痛药、患者自评疼痛评分和不良反应的变化。
本研究纳入了 16 例患有复杂癌症治疗耐药性疼痛的患者，其中 14 例患者患有转移性疾病。疼痛在 14 例患者中被分类为混合伤害性神经痛，在 2 例患者中被分类为神经痛。13 例患者与预先设定的阿片类药物共开美沙酮。美沙酮与阿片类药物突破性镇痛剂减少 61%±28%（p<0.001）和共开阿片类药物减少 17%±12%（p=0.015）呈统计学显著相关。患者自评疼痛评分也显著降低（p<0.001）。
美沙酮似乎在治疗复杂癌痛、神经痛、阿片类药物耐受和阿片类药物诱发的痛觉过敏方面具有特定作用，这可能归因于 N-甲基-D-天冬氨酸受体拮抗作用。
