Hao Xing, Zhou Yiting, Ling Yingxian, Miyoshi Hirotsugu, Sumitani Masahiko, Chan Kwok Ying, Park Hue Jung, Feng Zhiying, Rao Yuefeng
Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Hangzhou, China.
Ann Transl Med. 2022 Sep;10(18):998. doi: 10.21037/atm-22-4242.
Pain is a common symptom among cancer patients and directly affects their prognosis. As the leading drug for pain management, opioids are widely prescribed. So it is necessary to get people a correct understanding and application of opioids. In order to examine whether the use of high-dose opioids might affect survival and quality of life, this retrospective cohort study was performed to explore the outcomes of patients receiving high-dose opioids for pain management in a first-class tertiary hospital in China.
We retrospectively searched medical records of inpatients and outpatients with pain who were treated with opioids in The First Affiliated Hospital, Zhejiang University School of Medicine from July to December 2021. Forty-three cases who were treated with high-dose opioids meeting inclusion criteria. Among these patients, 37 had cancer pain and 6 had neuropathic pain. All patients had regular follow-up when readmission until to April 7, 2022. Medical records of patients on high-dose opioids (equivalent to morphine ≥300 mg/d) was collected, including numerical rating scale (NRS), Karnofsky performance score (KPS), survival and adverse drug reactions (ADRs). Pain relief, quality of life, survival, and ADRs of patients after pain treatment were analyzed and evaluated.
The NRS score was significantly reduced and pain was relieved after high-dose opioid treatment. The before and after average NRS score of cancer pain was 5.2±1.6 2.2±1.1 points (P<0.001), neuropathic pain was 5.0±2.2 1.3±1.2 points (P<0.05), respectively. Although there is no statistical difference, quality of life showed a trend of improvement compared with before treatment. The before and after average KPS scores of cancer pain patients was 55.7±17.3 62.4±20.0, and neuropathic pain patients was 71.7±9.0 83.3±4.7. There were no intolerable ADRs. The median survival time was 238 days and 83 days in patients with cancer pain who received high-dose opioids and ultra-high dose opioids (equivalent to morphine ≥600 mg/d).
Multimodal high-dose opioid pain treatments are important approaches to effectively relieve moderate to severe pain and improve the quality of life of patients. This study provides a clinical basis for future pain treatment with high-dose opioids.
疼痛是癌症患者的常见症状，直接影响其预后。作为疼痛管理的主要药物，阿片类药物被广泛处方。因此，有必要让人们正确认识和使用阿片类药物。为了研究大剂量阿片类药物的使用是否会影响生存和生活质量，本回顾性队列研究旨在探讨中国一家一流三甲医院中接受大剂量阿片类药物进行疼痛管理的患者的结局。
我们回顾性检索了2021年7月至12月在浙江大学医学院附属第一医院接受阿片类药物治疗的疼痛门诊和住院患者的病历。43例患者接受了符合纳入标准的大剂量阿片类药物治疗。其中，37例患有癌痛，6例患有神经性疼痛。所有患者再次入院时均定期随访至2022年4月7日。收集接受大剂量阿片类药物（相当于吗啡≥300mg/d）治疗患者的病历，包括数字评分量表（NRS）、卡氏功能状态评分（KPS）、生存情况和药物不良反应（ADR）。对疼痛治疗后患者的疼痛缓解情况、生活质量、生存情况和ADR进行分析和评估。
大剂量阿片类药物治疗后NRS评分显著降低，疼痛得到缓解。癌痛患者治疗前后平均NRS评分分别为5.2±1.6分和2.2±1.1分（P<0.001），神经性疼痛患者分别为5.0±2.2分和1.3±1.2分（P<0.05）。虽然无统计学差异，但生活质量与治疗前相比呈改善趋势。癌痛患者治疗前后平均KPS评分分别为55.7±17.3和62.4±20.0，神经性疼痛患者分别为71.7±9.0和83.3±4.7。未出现无法耐受的ADR。接受大剂量阿片类药物和超大剂量阿片类药物（相当于吗啡≥600mg/d）治疗的癌痛患者中位生存时间分别为238天和83天。
多模式大剂量阿片类药物疼痛治疗是有效缓解中重度疼痛、提高患者生活质量的重要方法。本研究为未来大剂量阿片类药物疼痛治疗提供了临床依据。
