Dellemijn P L, van Duijn H, Vanneste J A
Department of Neurology, Saint Lucas Andreas Hospital, Amsterdam, The Netherlands.
J Pain Symptom Manage. 1998 Oct;16(4):220-9. doi: 10.1016/s0885-3924(98)00070-0.
Forty-eight patients with noncancer neuropathic pain who had participated in a randomized controlled trial with intravenous fentanyl (FENiv) infusions received prolonged transdermal fentanyl (FENtd) in an open prospective study. Pain relief, side effects, tolerance, psychological dependence, mood changes, and quality of life were evaluated. The value of clinical baseline characteristics and the response to FENiv also was evaluated in terms of the outcome with long-term FENtd. Eighteen patients stopped prematurely because of insufficient pain relief, side effects, or both. Among the remaining 30 patients completing the 12-week dose titration protocol, pain relief was substantial in 13 and moderate in five. Quality of life improved (23%, P < 0.01). Psychological dependence or the induction of depression was not observed. In only one patient did tolerance emerge. There was a significant positive correlation between the pain relief obtained with FENiv and that with prolonged FENtd (r = 0.59, P < 0.0001). We conclude that (1) long-term transdermal fentanyl may be effective in noncancer neuropathic pain without clinically significant management problems and (2) A FENiv-test may assist in selecting neuropathic pain patients who might benefit from prolonged treatment with FENtd.
48例参与静脉注射芬太尼（FENiv）输注随机对照试验的非癌性神经病理性疼痛患者，在一项开放性前瞻性研究中接受了延长疗程的透皮芬太尼（FENtd）治疗。对疼痛缓解情况、副作用、耐受性、心理依赖、情绪变化和生活质量进行了评估。还根据长期FENtd的结果评估了临床基线特征值和对FENiv的反应。18例患者因疼痛缓解不足、出现副作用或两者兼而有之而提前停药。在其余30例完成12周剂量滴定方案的患者中，13例疼痛得到显著缓解，5例疼痛得到中度缓解。生活质量有所改善（23%，P<0.01）。未观察到心理依赖或抑郁的诱发情况。仅1例患者出现耐受性。FENiv获得的疼痛缓解与延长疗程的FENtd获得的疼痛缓解之间存在显著正相关（r=0.59，P<0.0001）。我们得出结论：（1）长期透皮芬太尼可能对非癌性神经病理性疼痛有效，且无临床上显著的管理问题；（2）FENiv试验可能有助于选择可能从延长疗程的FENtd治疗中获益的神经病理性疼痛患者。
