Mercadante S, Casuccio A, Agnello A, Serretta R, Calderone L, Barresi L
Pain Relief and Palliative Care, Societá a Maluto Oncologico Terminale, University of Palermo, Italy.
J Clin Oncol. 1998 Nov;16(11):3656-61. doi: 10.1200/JCO.1998.16.11.3656.
The aim of this study was to evaluate the analgesic and adverse effects and the doses of methadone in comparison to morphine.
A prospective randomized study was performed in a sample of 40 patients with advanced cancer who required strong opioids for their pain management. Patients were treated with sustained-release morphine or methadone in doses titrated against the effect administered two or three times daily according to clinical need. Opioid doses, adjuvant medications, symptoms associated with opioid therapy, pain intensity, and pain mechanisms were recorded. The opioid escalation indices in percentage (OEI%) and milligrams (OEImg) were calculated. The effective analgesic score (EAS) that monitors the analgesic consumption-pain ratio was also calculated at fixed weekly intervals.
differences in pain intensity were found. Patients treated with methadone reported values of OEI significantly less than those observed in patients treated with morphine. Seven patients in the methadone group maintained the same initial dosage until death, whereas only one patient in the morphine group did not require opioid dose escalation. A more stable analgesia in time in patients treated with methadone was shown by the low number of gaps in EASs reported. Symptom frequencies and intensities were similar in the two groups.
Methadone is a drug of indisputable value in the treatment of cancer pain, and an unbalanced focus on the risks of inappropriate use rather than the benefits should not compromise the use of a relevant alternative to morphine in the management of cancer pain.
本研究旨在评估美沙酮与吗啡相比的镇痛效果、不良反应及剂量。
对40例晚期癌症患者进行了一项前瞻性随机研究，这些患者因疼痛管理需要使用强效阿片类药物。根据临床需要，患者接受缓释吗啡或美沙酮治疗，剂量根据效果进行滴定，每天给药两到三次。记录阿片类药物剂量、辅助用药、与阿片类药物治疗相关的症状、疼痛强度和疼痛机制。计算阿片类药物升级指数的百分比（OEI%）和毫克数（OEImg）。还在固定的每周间隔计算监测镇痛药物消耗-疼痛比值的有效镇痛评分（EAS）。
发现疼痛强度存在差异。接受美沙酮治疗的患者报告的OEI值明显低于接受吗啡治疗的患者。美沙酮组有7例患者直至死亡维持相同的初始剂量，而吗啡组只有1例患者不需要增加阿片类药物剂量。美沙酮治疗患者的EAS报告中间隙数量较少，表明镇痛效果在时间上更稳定。两组的症状频率和强度相似。
美沙酮在癌症疼痛治疗中具有无可争议的价值，不应因过度关注不当使用的风险而非益处，而影响其在癌症疼痛管理中作为吗啡相关替代药物的使用。
