Mercadante S, Dardanoni G, Salvaggio L, Armata M G, Agnello A
Department of Anesthesiology, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
J Pain Symptom Manage. 1997 Apr;13(4):204-12. doi: 10.1016/s0885-3924(96)00302-8.
Until now, there have not been any parameters to monitor opioid therapy in cancer patients with pain. In this study, 325 consecutive advanced cancer patients were scheduled for a prospective longitudinal survey. After exclusions, 67 patients were surveyed. All included patients were advanced cancer patients with pain that required opioid therapy for more than 6 weeks before death. Opioid escalation, symptoms associated with opioid therapy, pain mechanism, and pain intensity were recorded. Indices were calculated to categorize the response to opioids. The opioid escalation index (OEI) was used to index the mean increase of the starting opioid dosage, expressed as a percentage or in mg. The length of the period of stable dose (MLD) and the effective analgesic score (EAS), that is, the analgesic consumption/pain relief ratio calculated at fixed intervals, were also used. Patients with a mean visual analogue scale score (VAS) of less than 4 and regular OEI and EAS were considered responsive; patients with a mean VAS less than 4 but with an OEI more than 5 or increases of more than 100% of EAS when compared to that calculated the week before were considered mildly responsive; and patients with a mean VAS more than 4 were considered unresponsive. Advanced age, female gender, and previous chemotherapy were all factors reducing OEI. Head and neck cancer was associated with a higher OEI. Regarding the influence of the opioid-related symptoms, an increased OEI was associated with the presence of confusion. Moreover the presence of confusion was associated with neuropathic pain. Neuropathic pain taken alone, however, did not influence this score. Gender-specific cancer, such as breast cancer, influenced the gender differences reported for MLD (significantly longer than that reported for males and other primary tumor). Good responsiveness was observed in 28 patients, partial responsiveness in 33 patients, unresponsiveness in six patients. Psychological factors were associated with poor pain relief, probably reducing the patient's compliance. The tools used in this study may be useful in monitoring the effects of opioid therapy in cancer pain patients. Simple numbers are easy to compare and make it possible to profile opioid responsiveness and differences among patients.
到目前为止，尚无用于监测癌症疼痛患者阿片类药物治疗效果的参数。在本研究中，325例连续的晚期癌症患者被纳入一项前瞻性纵向调查。排除部分患者后，对67例患者进行了调查。所有纳入患者均为晚期癌症疼痛患者，在死亡前需要接受超过6周的阿片类药物治疗。记录阿片类药物剂量增加情况、与阿片类药物治疗相关的症状、疼痛机制和疼痛强度。计算各项指标以对阿片类药物的反应进行分类。阿片类药物剂量增加指数（OEI）用于表示起始阿片类药物剂量的平均增加量，以百分比或毫克为单位。还使用了稳定剂量期长度（MLD）和有效镇痛评分（EAS），即固定间隔计算的镇痛药物消耗量/疼痛缓解率。平均视觉模拟量表评分（VAS）小于4且OEI和EAS正常的患者被视为反应良好；平均VAS小于4但OEI大于5或与前一周计算的EAS相比增加超过100%的患者被视为反应轻度良好；平均VAS大于4的患者被视为无反应。高龄、女性和既往化疗均为降低OEI的因素。头颈癌与较高的OEI相关。关于阿片类药物相关症状的影响，OEI增加与意识模糊的存在有关。此外，意识模糊的存在与神经性疼痛有关。然而，单独的神经性疼痛并不影响该评分。特定性别的癌症，如乳腺癌，影响了报告的MLD性别差异（显著长于男性和其他原发性肿瘤）。28例患者反应良好，33例患者部分反应良好，6例患者无反应。心理因素与疼痛缓解不佳有关，可能会降低患者的依从性。本研究中使用的工具可能有助于监测阿片类药物治疗癌症疼痛患者的效果。简单的数据便于比较，能够描绘出阿片类药物反应性以及患者之间的差异。
