Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.

PURPOSE: To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain. PATIENTS AND METHODS: Patients in international palliative care clinics with pain requiring initiation of strong opioids were randomly assigned to receive methadone (7.5 mg orally every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained release every 12 hours and 5 mg every 4 hours as needed). The study duration was 4 weeks. RESULTS: A total of 103 patients were randomly assigned to treatment (49 in the methadone group and 54 in the morphine group). The groups had similar baseline scores for pain, sedation, nausea, confusion, and constipation. Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%) than those receiving morphine (three of 54; 6%; P =.019). The opioid escalation index at days 14 and 28 was similar between the two groups. More than three fourths of patients in each group reported a 20% or more reduction in pain intensity by day 8. The proportion of patients with a 20% or more improvement in pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of patient-reported global benefit were nearly identical to the pain response rates and did not differ between the treatment groups. CONCLUSION: Methadone did not produce superior analgesic efficiency or overall tolerability at 4 weeks compared with morphine as a first-line strong opioid for the treatment of cancer pain.     

恶性肿瘤患者临终前的阿片类药物止痛回顾

目的:调查恶性肿瘤患者临终前的阿片类药物止痛治疗现状。方法:分析242例患者阿片类药物止痛的基本情况,比较不同性别、年龄及肿瘤原发灶的阿片止痛情况。结果:176例(72.73%)用阿片止痛,其中134例(76.14%)用美施康定,28例(15.91%)用多瑞吉,14例(7.95%)用弱阿片,无阿片过量引起的死亡。日平均吗啡口服剂量:男性(166.67mg)明显高于女性(107.66mg),年龄增大,用量逐渐减小,但无显著差异,不同原发灶的患者无显著差异。结论:止痛治疗合理、安全;男性止痛所需阿片量比女性大,年龄大的患者阿片用量较小,肿瘤原发灶与阿片止痛剂量无关。     

盐酸吗啡缓释片联合普瑞巴林治疗癌性神经性疼痛的临床疗效

目的:探讨盐酸吗啡缓释片联合普瑞巴林用于治疗癌性神经性疼痛的疗效及安全性。方法:将95例癌性神经性疼痛患者随机分为盐酸吗啡缓释片联合普瑞巴林组、盐酸吗啡缓释片单药组、普瑞巴林单药组,进行为期60天的治疗。分别记录三种治疗方案试验开始和结束时普瑞巴林和盐酸吗啡缓释片日用量、NRS评分、生活质量评分和不良反应。结果:在治疗结束时,联合治疗组［(40.8±5.23) mg和(178.5±8.93) mg］相比于盐酸吗啡缓释片单药组［(63.8±6.37) mg］和普瑞巴林单药组［(284.3±8.74) mg］,每日平均有效治疗剂量更低,差异有统计学意义（P<0.05）;与盐酸吗啡缓释片单药和普瑞巴林单药相比,联合治疗组中疼痛对患者日常活动的干扰显著减少,差异有统计学意义（P<0.05）;盐酸吗啡缓释片与普瑞巴林联合组、盐酸吗啡缓释片单药组及普瑞巴林单药组患者均出现便秘、嗜睡、外周性水肿、呕吐等不良反应,差异无统计学意义（P>0.05）。结论:盐酸吗啡缓释片与普瑞巴林联合用于治疗癌性神经性疼痛安全有效,疗效优于单用盐酸吗啡缓释片或普瑞巴林。     

芬太尼透皮贴剂与口服吗啡用于癌痛病人的比较

目的　比较芬太尼透皮贴剂与口服吗啡用于癌痛病人的副作用。方法　癌痛病人 5 6例 ,随机分为两组 ,每组 2 8例。组A应用芬太尼 5mg/贴 /3d ,按剂量换算 ,组B应用口服缓释吗啡 5 0mg ,2次 /d。应用 9d后 ,采用视觉模拟评分法 (VAS法 )评价止痛疗效 ,同时比较两组副作用。结果　两组用药后止痛效果明显 ,两组间疼痛缓解程度无显著差异 (P >0 .0 5 ) ,两组副作用中便秘的发生率却有显著性差异 (P <0 .0 1)。结论　应用芬太尼透皮贴剂用于癌痛病人的便秘发生率较口服吗啡低。     

加巴喷丁联合吗啡治疗癌痛的临床观察

目的：观察加巴喷丁联合吗啡治疗癌痛的临床效果。方法：35例晚期癌症伴疼痛的患者,VAS评分≥6分,年龄32—69岁,随机分为M组、G组、MG组三组,分别给予吗啡,加巴喷丁,加巴喷丁＋吗啡,直至疼痛缓解（VAS≤3分）,比较治疗前后的疼痛缓解程度、吗啡用药量、生活质量和副作用,并检测疼痛介质的改变。结果：与治疗前相比,三组患者的疼痛程度有不同程度的缓解,MG组的患者疼痛减轻程度要大于M组（P〈0．05）和G组（P〈0．05）;MG组的吗啡消耗量比M组少;各组的疼痛介质在治疗后均低于治疗前（P〈0．05）;MG组的副作用少于M组,患者生活质量明显提高。结论：加巴喷丁联合吗啡能有效控制癌痛,可以减少吗啡的用量及其副作用并改善患者生活质量。     

Randomized Trial of Opioids Versus Tricyclic Antidepressants for Radiation-Induced Mucositis Pain in Head and Neck Cancer

Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant (TC), commonly used in the treatment of neuropathic pain, with the effect of opioids on radiation-induced mucositis pain. Forty-three patients receiving 66-68 Gy external radiation according to the DAHANCA guidelines (the Danish Head and Neck Cancer Study Group) were randomized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics. Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm. Pain was evaluated weekly using a VAS scale and the McGill Pain Questionnaire. The degree of mucositis and the degree of depression were measured at the same time intervals. Twenty-two patients entered the opioid arm and 21 the TC arm. Two patients in each arm were non-evaluable. VAS pain scores were significantly reduced in the opioid treatment arm one week after randomization (p=0.01). Eight patients in the TC arm were managed with TC alone, but for 11 patients it was necessary to add morphine. The 20 evaluable patients in the morphine arm required no additional treatment. There were no significant differences in side effects between the two groups. Higher pain scores in the TC arm, but not in the opioid arm, were significantly correlated with higher BDI scores. Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone. This might be useful in patients with relative counter-indications to opioid treatment.     

酮咯酸对术后痛和癌痛的镇痛疗效观察

目的研究酮咯酸对术后痛和癌痛的镇痛作用。方法将胸部手术后痛患者４０例随机分成酮咯酸组２０例和吗啡组２０例。前者给酮咯酸３０ｍｇ肌肉注射；后者给予硬膜外腔注射吗啡２ｍｇ。结果治疗后酮咯酸组的ＶＡＳ评分为０．９５±０．２８；吗啡组为０．７０±０．１６，差异无显著意义（Ｐ＞０．０５）。另外，对１５例术后痛患者和１５例癌痛患者口服酮咯酸１０ｍｇ，进行镇痛效果的比较，用药后术后痛组ＶＡＳ评分为０．２３±０．１６；癌痛组为２．４２±０．４５，两组差异有显著意义（Ｐ＜０．０１）。无明显不良反应。结论酮咯酸缓解术后痛优于癌痛。     

硫酸吗啡控释片与盐酸吗啡缓释片治疗121例中、重度癌痛患者的疗效比较

背景与目的:硫酸吗啡控释片、盐酸吗啡缓释片均是治疗中、重度癌痛的首选药物之一,两者在作用、代谢、不良反应等方面有一定差异.本研究的目的是比较硫酸吗啡控释片、盐酸吗啡缓释片治疗中、重度癌痛患者的疗效和不良反应.方法:对121例有中、重度癌痛的患者进行随机分组,其中61例采用硫酸吗啡控释片、60例采用盐酸吗啡缓释片治疗,观察两药疗效和不良反应.结果:硫酸吗啡控释片组中中度疼痛12例,重度疼痛的例,治疗后有效率91.80%;盐酸吗啡缓释片组中中度疼痛13例,重度疼痛47例,治疗后有效率91.67%,两组比较在镇痛效果上差异无统计学意义.消化道反应(恶心、呕吐、便秘),盐酸吗啡缓释片较硫酸吗啡控释片发生率高(66.66%vs.4.43%),差异有统计学意义(P＜0.05).结论:硫酸吗啡控释片、盐酸吗啡缓释片用于治疗中、重度癌痛,疗效相近,安全性好,不良反应可耐受.对年龄大,既往有消化道疾病的患者,推荐使用硫酸吗啡控释片.     

Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it?

BACKGROUND: Management of cancer pain is one of the most important goals of palliative care. Relieving pain is often problematic. High doses of morphine at home may be required to relieve patients' pain, and is therefore feared. The goals of the current study were to assess the feasibility of high-dose morphine use at home, to characterize the patients, and to examine whether the use of high-dose morphine might affect their survival. METHODS: The authors retrospectively studied the medical charts of 661 outpatients, which were completed by a home-care hospice team. The authors collected data regarding demographic parameters, medical diagnosis, pain type, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time as associated with morphine dosage. The authors also compared the data of patients receiving high-dose morphine with those of a group of patients receiving regular doses. RESULTS: The authors identified 435 patients (65.8%) who received morphine for pain relief. Of these, 396 patients (91%) received a dose of 5-299 mg of morphine per day), 32 patients (7.4%) received 300-599 mg of morphine per day), and 7 patients (1.6%) received very high doses (> or = 600 mg of morphine per day). Overall, 39 patients (9%) received > 299 mg per day. Morphine dosage was found to be inversely correlated (r) with age (r = -0.254; P < 0.001). Male patients required slightly higher dosages than female patients (62.5% of high-dose and 71% of very high-morphine groups, respectively). Primary gastrointestinal (P = 0.015) and lung (P = 0.027) carcinomas, as well as metastatic bone disease (P = 0.001), ovarian carcinoma (P = 0.037), and brain tumors (P = 0.0053) were associated with higher and very higher morphine dosages. Adverse effects were similar in the groups receiving regular, high, and very high doses of morphine. The median survival of patients treated with high doses of morphine was 27 days and was 37 days for those treated with very high doses. Patients treated with low doses of morphine survived for 18 days. Patients not treated with morphine survived for 22 days (P = 0.001 by Mantel-Cox analysis; P = 0.029 by Breslow analysis). CONCLUSIONS: The use of high and very high morphine doses at home proved safe and did not appear to affect the patients' life expectancy adversely. The use of high or very high-dose morphine should not be a barrier to providing palliative terminal care for home-care hospice patients.     

羟考酮控释片作为止痛背景用药在中重度癌痛滴定中的临床观察

目的 评价羟考酮控释片在中重度癌痛滴定中的有效性和安全性。方法 81例既往未接受阿片类药物治疗的中重度癌痛（疼痛评分＞3）患者随机分成2组：A组（42例）接受吗啡即释片10 mg q4 h滴定;B组（39例）接受羟考酮控释片10 mg q12 h为背景止痛药的滴定。后按照NCCN疼痛治疗指南的要求滴定,24 h后2组均根据吗啡使用总量调整羟考酮控释片用量。观察期为24 h,服药后1 h开始根据疼痛数字评价量表（NRS）进行评分,比较两组疗效和不良反应的发生率。结果 24 h观察期内吗啡即释片组的疼痛缓解率为82.9％,羟考酮控释片组为87.2％;滴定4 h,吗啡即释片组的疼痛缓解率为58.3％,羟考酮控释片组为77.0％,两组差异有统计学意义（P＜0.05）;滴定12 h,两组疼痛缓解率接近,差异无统计学意义（P>0.05）。两组患者主要不良反应为便秘、恶心呕吐、头晕、口干、嗜睡、尿潴留,经过对症处理均可耐受。结论 羟考酮控释片作为止痛背景用药在中重度癌痛滴定中与吗啡即释片的疗效及安全性相当,但止痛治疗的稳定性更佳。     

晚期消化系统肿瘤疼痛患者大剂量吗啡治疗的临床护理研究

目的探讨晚期消化系统肿瘤疼痛患者大剂量吗啡治疗及护理的临床疗效。方法选择2010年6月至2013年6月接受大剂量吗啡治疗的晚期消化系统肿瘤疼痛患者34例,所有患者均给予大剂量吗啡静脉输液泵输入治疗,起始剂量为为口服剂量的30%,效果不显著者适当增加吗啡剂量,吗啡剂量220⁵50mg/d,对患者进行静脉输注泵、输液管、镇痛、不良反应等护理,观察疗效。结果疼痛完全缓解18例(52.9%),部分缓解16例(47.1%),疼痛缓解有效率为100%。在治疗过程中,出现轻微头昏嗜睡、恶心呕吐、血压降低、呼吸抑制、便秘、幻觉谵妄、欣快感等不良反应,经对症治疗、减少吗啡剂量以及时间延长后,不良反应均显著减轻或消失。结论晚期消化道肿瘤疼痛患者使用大剂量吗啡治疗与护理,能有效缓解患者极度疼痛,提高生活质量,值得临床推广应用。     

The opioid combination of transdermal fentanyl and sustained release morphine for refractory cancer pain--a case report

Transdermal fentanyl (TDF) has been increasingly administered for the management of cancer pain. Occasionally, some patients fail to obtain poor analgesic effects with its dose escalation. We discuss a case of a 44-year-old male diagnosed with lung cancer with back pain caused by bone metastasis. He was administered a TDF of 75 microg/hr with good pain relief on admission. With time, the dose escalation to 300 microg/hr induced neuroexcitatory adverse effects without pain improvement. The conversion to 150 microg/hr TDF and sustained-release oral morphine 360 mg/day provided effective pain control. This clinical phenomenon demonstrated a possible association with the development of opioid tolerance. Although several experimental approaches regarding partial opioid substitution or combining different opioids for better pain control were suggested, the basic studies of opioid tolerance do not justify conclusions. In this case, partial opioid rotation and opioid combination were beneficial approaches to pain management.     

氟比洛芬酯联合吗啡自控静脉镇痛治疗肝癌半肝切除术后疼痛的疗效观察

目的:观察氟比洛芬酯注射液联合吗啡自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）治疗半肝切除术后疼痛的镇痛效果及不良反应。方法:半肝切除术患者50例,按照随机数字表法分为单纯吗啡PCIA对照组和氟比洛芬酯注射液联合吗啡PCIA实验组,每组25 例,连续观察72小时。分别就两组治疗后疼痛缓解、吗啡用量、爆发痛镇痛起效时间和不良反应等方面进行评价。结果:对照组疼痛缓解率为88.0%;实验组疼痛缓解率为92.0%,两组镇痛作用无显著性差异（P>0.05）。实验组在减少阿片类止痛药剂量,缓解疼痛时间,减轻阿片类药物引起恶心、便秘、嗜睡、谵语、延长排气发生率方面明显优于对照组(P<0.05)。结论:氟比洛芬酯注射液与吗啡联合治疗肝癌半肝切除术后疼痛,可减少阿片类药物用量,降低阿片类不良反应,促进术后恢复。     

盐酸羟考酮缓释片12 小时滴定方案用于中重度癌痛患者的有效性和安全性—前瞻性 随机 开放 多中心 平行对照研究

  目的  阿片类药物是中、重度癌痛治疗的首选药物。目前以缓释阿片类药物为背景的滴定方法的剂量调整时机和方式还需进一步探索。本研究旨在评估盐酸羟考酮缓释片12 h滴定方案用于中重度癌痛患者的有效性和安全性。  方法  选择 2018年2月至2019年12月浙江省24家医院收治的中重度阿片类药物未耐受癌痛患者114例[数字分级法（numerical rating scale,NRS）≥4 分]作为研究对象。筛选出合并1次以上爆发痛且存在中重度以上疼痛（NRS≥4 分）患者87例,按盐酸羟考酮缓释片调整的时间不同分为试验组（12 h滴定组,n=45）和对照组（24 h滴定组,n=42）。试验组起始给予盐酸羟考酮缓释片10 mg并根据疼痛情况给予即释吗啡补救镇痛,12 h后根据即释吗啡量调整剂量,剂量调整为背景剂量+12 h内即释吗啡剂量。对照组起始剂量给予盐酸羟考酮缓释片10 mg q12h,并根据疼痛情况给予即释吗啡补救镇痛,24 h后剂量调整为背景剂量+24 h内即释吗啡剂量/2。比较两组24 、48、72 h的疼痛缓解率、不良反应发生率、即释吗啡补救镇痛情况及使用量、生活质量评分,以及镇痛满意度。  结果  给药后24 、48 、72 h,试验组和对照组均显示出较高的疼痛缓解率,组间比较差异无统计学意义（P>0.05）。相对于对照组,试验组在24 、48 及72 h补救镇痛次数及剂量均显著减少（P<0.05）。两组患者不良反应大多数为轻中度,发生率比较差异无统计学意义（P>0.05）。镇痛满意度水平均较高,组间比较差异无统计学意义（P>0.05）。  结论  在中重度癌痛患者应用盐酸羟考酮缓释片为背景的滴定方案中,12 h调整剂量能有效减少补救镇痛次数及剂量,维持较高的镇痛缓解率和镇痛满意度,安全性良好。      

Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study

BACKGROUND: Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients. We thus retrospectively examined the pain management and need for opioid switching in cancer patients admitted to our palliative care unit. METHODS: Of 354 patients admitted to our palliative care unit from 2004 through 2005, 81 patients were pre-treated with transdermal fentanyl. Demographic and cancer-related data (diagnosis, symptoms, pain score on a numeric rating scale (NRS)), analgesic dose at admission and discharge were compared. Statistics: mean +/- SD, ANOVA, Wilcoxon's test was used for inter-group comparisons, significance P < 0.05, adjusted for multiple testing. Pain scores are given in median (range). RESULTS: Mean transdermal fentanyl dose at admission was 81.0 +/- 55.8 microg/h. In 79 patients transdermal fentanyl treatment was discontinued. In two patients, analgesic treatment according to WHO I provided sufficient pain relief. The other 77 patients were switched to other opioids: 33 patients to oral morphine and 44 to oral hydromorphone. In patients switched to morphine the dose at discharge (104.7 +/- 89.0 mg) was lower than at admission (165.5 mg morphine equivalence). In patients switched to hydromorphone the dose of 277.8 +/- 255.0 mg morphine equivalent was higher at discharge than at admission (218.2 +/- 131.4 mg morphine equivalence--considering an equianalgesic conversion ratio morphine: hydromorphone = 7.5: 1). Pain scores decreased significantly after opioid rotation (NRS at rest/on exertion: 4 (0-10)/7 (2-10) versus 1 (0-3)/2 (0-5); P < 0.001). CONCLUSIONS: In the patient group switched to morphine, sufficient pain relief was achieved by lower equianalgesic morphine doses, compared with the doses at admission. In the patient group switched to hydromorphone, higher equianalgesic morphine doses were needed at discharge, considering an equianalgesic conversion ratio of morphine: hydromorphone = 7.5: 1. Patients with far advanced cancer often suffer from sweating and cachexia, which may have negative effects on the absorption of transdermal fentanyl. Opioid switching to oral morphine or hydromorphone was well tolerated and proved to be an efficacious option for cancer pain treatment.     

癌痛治疗120例临床分析

目的调查中重度癌痛患者强阿片类及第一类精神药物的使用情况。方法从疾病类别、患者年龄及性别方面,回顾性分析120例中重度癌痛患者使用强阿片类药物、曲马多口服制剂、盐酸布桂嗪针剂的情况。结果使用强阿片类药物的患者中,男性多于女性（P=0.004〈0.05）。强阿片类、曲马多口服制剂及盐酸布桂嗪针剂的日最大剂量男性均大于女性。使用强阿片类药物（P=0.030〈0.05）和盐酸布桂嗪针剂者（P=0.019〈0.05）的日平均剂量,男性也大于女性。≥60岁组便秘发生率高于〈60岁组,差异具有统计学差异（P=0.023〈0.05）。结论癌痛患者中男性使用强阿片类药物的比率高于女性,且强阿片类药物与盐酸布桂嗪针剂的日平均应用剂量也高于女性。50～59岁组强阿片类药物的日平均应用剂量最高。因强阿片类药物对老年患者的不良反应较重,尤其是便秘,该类药用药剂量应酌减。     

Basic studies on cancer pain control

According to the World Health Organization (WHO) guidelines for patients with moderate or severe pain, morphine has been used as a "gold standard" treatment for cancer pain. Recent clinical experiences have demonstrated that when morphine is used to control pain in cancer patients, psychological dependence is not a major concern. However, undue anxiety about psychological dependence on morphine in cancer patients has caused physicians and patients to use inadequate doses of opioids. In basic research, we reported that the morphine-induced rewarding effects can be dramatically suppressed under a neuropathic pain-like state induced by sciatic nerve ligation and an inflammatory pain-like state produced by intraplantar injection of formalin or carrageenan in rodents. The use of morphine for the treatment of pain is sometimes accompanied with side effects such as emesis, constipation and drowsiness. We show that the lower doses of morphine produce emesis, whereas antinociceptive doses of morphine show no emetic responses in ferrets. These findings provide further evidence that an adequate dose of morphine is useful and safe in a clinical setting.     

Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial.

PURPOSE: To determine whether adding regular acetaminophen (paracetamol) could improve pain and well-being in people with advanced cancer and pain despite strong opioids. PATIENTS AND METHODS: Participants took acetaminophen for 48 hours and placebo for 48 hours. The order (acetaminophen or placebo first) was randomly allocated. Pain was the primary outcome. Preferences, number of opioid breakthrough doses, overall well-being, nausea and vomiting, drowsiness, constipation, and cold sweats were secondary outcomes. Patients rated themselves daily with visual analog scales (VAS) and a verbal numeric scale (VNS) for pain, all scaled from 0 to 10. RESULTS: Thirty patients completed the trial. The oral opioid was morphine in 23 patients and hydromorphone in seven patients. The median daily opioid dose in oral morphine equivalents was 200 mg (range, 20 to 2,100 mg). Nonsteroidal anti-inflammatory drugs, corticosteroids, or both were used by 16 patients. Pain and overall well-being were better for patients receiving acetaminophen than for those receiving placebo. The mean difference was 0.4 (95% CI, 0.1 to 0.8; P =.03) in VNS for pain, 0.6 (95% CI, -0.1 to 1.3; P =.09) in VAS for pain, and 0.7 (95% CI, 0.0 to 1.4; P =.05) in VAS for overall well-being. More patients preferred the period they took acetaminophen (n = 14) than the period they took placebo (n = 8), but many had no preference (n = 8). There were no differences in the other outcomes. CONCLUSION: Acetaminophen improved pain and well-being without major side effects in patients with cancer and persistent pain despite a strong opioid regimen. Its addition is worth considering in all such patients.     

氢溴酸高乌甲素联合阿片类药治疗中重度神经病理性癌痛疗效观察

目的探讨氢溴酸高乌甲素联合阿片类药与单独应用阿片药治疗中重度神经病理性癌痛的疗效差别。方法2003年1月至2007年12月间我院肿瘤科收治了63例神经病理性癌疼痛患者,Karnofsky评分50～80分,随机分为两组,其中A组采用氢溴酸高乌甲素联合阿片类镇痛药（32例）;B组单用阿片类镇痛药（31例）;疼痛评估采用视觉模拟评分法（visual analogue scale,VAS）,分析第0、3、10天的变化;评价两组阿片药品的消耗量以及不良反应的发生率。结果A、B组的VAS评分基线值差异无显著性（P=0.452）。从疼痛的缓解程度来看,VAS评分下降程度A组要好于B组,差异有显著性（P〈0.05）;从阿片类药物的消耗来看,B组明显要多于A组;阿片不良反应B组多于A组（P=0.015）。结论氢溴酸高乌甲素联合阿片类药可以更好地治疗患者神经病理性癌痛,减少了阿片药品的用量,降低了因为阿片药带来的不良反应,是治疗中重度神经病理性癌痛安全有效的办法。     

吗啡滴定给药与芬太尼透皮贴联合治疗晚期重度癌痛的临床疗效观察

目的：观察吗啡滴定给药与芬太尼透皮贴联合治疗因晚期消化道恶性肿瘤所引起重度癌痛患者的临床疗效。方法：40例晚期消化道的恶性肿瘤患者,用吗啡滴定给药与芬太尼透皮贴联合止痛治疗,观察疗效及不良反应。结果：40例晚期消化道的恶性肿瘤患者的疼痛均得到良好控制,72h 后评估发现大部分患者睡眠改善、食欲增加、精神好转。而且因单用吗啡所致的如便秘、恶心、呕吐、头晕等药物不良反应发生率也低。结论：吗啡滴定给药与芬太尼透皮贴联合治疗能有效控制重度癌痛并且不良反应发生率低。