芬太尼透皮贴剂治疗晚期癌性疼痛的疗效观察

目的 观察芬太尼透皮贴剂治疗晚期癌性疼痛患者的疗效.方法 2009年1月-2010年3月,对经病理学检查确诊为晚期恶性肿瘤的癌痛患者60例,使用芬太尼透皮贴剂进行止痛治疗.1周后观察患者疼痛缓解效果、KPS评分及芬太尼透皮贴剂不良反应.结果 癌痛患者治疗前、后疼痛的缓解程度、KPS评分,差异有统计学意义(P＜0.05)...     

芬太尼透皮贴剂控制癌性疼痛疗效观察

疼痛是晚期肿瘤患者的常见症状 ,按世界卫生组织(WHO)统计 ,大约有 30 %～ 5 0 %的癌症患者伴有疼痛 ,6 0 %～90 %的晚期癌症患者有不同程度的疼痛 ,其中 70 %以疼痛为主要症状[1] ,文献报道[2 ] 止痛不佳使生活质量降低 ,对有慢性疼痛的患者 ,止痛是决定生活质量的重要因素。因此控制疼痛 ,改善患者生活质量是晚期癌症治疗的关键。芬太尼透皮贴剂 (多瑞吉 )作为新近开发的强阿片类镇痛药 ,为不能吞服药物的患者提供了一种全新的镇痛治疗途径。为研究芬太尼透皮贴剂的镇痛效果和不良反应 ,我科于 2 0 0 0年 2月至 2 0 0 1年 2月 ,分别使用…     

芬太尼透皮贴剂治疗消化道癌痛的疗效观察及护理

目的观察芬太尼透皮贴剂治疗晚期消化道恶性肿瘤中重度疼痛的疗效、安全性及患者的生活质量，探讨晚期消化道癌痛更有效的治疗及护理措施。方法给予进食困难或用其他强阿片类口服药引起严重胃肠道反应的60例中、重度疼痛患者应用芬太尼透皮贴剂，初始剂量为25ug／h；用药期间根据疼痛程度进行剂量滴定。结果疼痛缓解率达到100％，其中完全缓解占63％，明显缓解占37％，发生不良反应的机率少、程度轻，主要症状为便秘、恶心、呕吐，通过适当的护理及对症处理后症状均消失，患者生活质量明显提高。结论芬太尼透皮贴剂治疗消化道恶性肿瘤中重度癌痛效果好，用药方便、副反应少、轻，能够明显提高患者的生活质量。     

芬太尼缓释透皮贴剂联合心理暗示治疗中重度癌性疼痛

目的评价芬太尼透皮贴剂(TDF)联合积极心理暗示对中重度癌性疼痛治疗的效果。方法将2011年1月-8月40例中重度癌性疼痛患者随机分为对照组和观察组,每组各20例。对照组患者采用TDF 50μg/h治疗,贴膜每3天更换一次;观察组患者在对照组治疗方法基础上,再联合积极心理暗示治疗。观察两组患者治疗前后疼痛改善情况及不良反应。结果观察组患者疼痛及生活质量均较对照组有明显改善。结论 TDF联合积极的心理暗示可以减轻患者疼痛程度,并可提高其生活质量。     

芬太尼透皮贴剂治疗癌性疼痛的疗效与护理

【目的】探讨多瑞吉（芬太尼透皮贴剂）治疗癌性疼痛的效果及护理。【方法】52例伴有中重度疼痛的癌症患者给予多瑞吉镇痛治疗,剂量范围为25-200gg／h,贴膜每72h更换1次,评估患者治疗前后疼痛缓解程度,生活质量改善情况及出现的不良反应。【结果】本组总的疼痛缓解率92．3％,不良反应轻,患者的生活质量有所提高。【结论】多瑞吉治疗癌性疼痛并辅助相应的护理措施疗效明显。     

芬太尼透皮贴剂治疗消化道癌痛的疗效观察及护理

目的 观察芬太尼透皮贴剂治疗晚期消化道恶性肿瘤中重度疼痛的疗效、安全性及患者的生活质量,探讨晚期消化道癌痛更有效的治疗及护理措施.方法 给予进食困难或用其他强阿片类口服药引起严重胃肠道反应的60例中、重度疼痛患者应用芬太尼透皮贴剂,初始剂量为25 ug/h;用药期间根据疼痛程度进行剂量滴定.结果 疼痛缓解率达到100%,其中完全缓解占63%,明显缓解占37%,发生不良反应的机率少、程度轻,主要症状为便秘、恶心、呕吐,通过适当的护理及对症处理后症状均消失,患者生活质量明显提高.结论 芬太尼透皮贴剂治疗消化道恶性肿瘤中重度癌痛效果好,用药方便、副反应少、轻,能够明显提高患者的生活质量.     

芬太尼透皮贴治疗癌性疼痛46例疗效观察

目的：评价芬太尼透皮贴治疗癌性疼痛的疗效。方法：应用芬太尼透皮贴治疗癌性疼痛46例,剂量2.5～5mg粘贴皮肤,维持72小时。结果：总有效率91.3%,其中显效39.1%,有效52.2%,无效8.7%。毒副反应主要为便秘、恶心和嗜睡。结论：芬太尼透皮贴能有效减轻癌性疼痛,副作用低微。     

芬太尼透皮贴剂治疗晚期癌痛的观察

目的 观察芬太尼透皮贴剂（多瑞吉）对晚期癌痛伴有不能吞咽药物及使用吗啡出现严重反应的止痛效果及副作用。方法 观察晚期肿瘤中度以上疼痛，同时不能口服给药患使用多瑞吉的疗效及副作用。结果 完全缓解（CR）29例，部分缓解（PR）17例，轻度缓解（MR）8例，总有效率100％，CR＋PR为85．18％。结论 多瑞吉能有效的控制晚期肿瘤中度以上疼痛。     

芬太尼透皮贴剂治疗晚期癌痛的观察及护理对策

目的探讨芬太尼透皮贴剂(多瑞吉)治疗晚期癌痛的效果及护理对策。方法224例中、重度癌痛患者给予多瑞吉镇痛治疗，剂量为25～50μg/h，贴膜每3d更换1次，时间15．178d，评估患者止痛效果、不良反应及生活质量改善情况。结果总的疼痛缓解率96．4％，绝大多数不良反应能缓解，病人生活质量明显提高。结论多瑞吉治疗晚期癌痛疗效明显，辅助相应的护理措施，效果更显著，不良反应少，能够改善患者的生活质量。     

芬太尼透皮贴剂治疗疼痛的疗效观察

对我科 2 0 0 1- 0 1- 0 1～ 2 0 0 1- 12 - 31强效阿片类镇痛药芬太尼透皮贴剂的疗效总结如下。1　对象和方法1.1　对象　本组 4 0例 ,男 32例 ,女 8例 ,平均年龄 6 7岁 ,其中带状疱疹后遗神经痛患者 17例 ,慢性腰背痛患者 3例 ,癌痛患者 2 0例。1.2　方法　疗效评定 :采用 VAS评分法对患者疼痛程度进行评分 ,0分为无痛 ,10分为剧烈疼痛 ,1～ 3分为轻度疼痛 ,4～ 6分为中度疼痛 ,7～ 10分为重度疼痛 ,同时采用加权法对患者的VAS评分进行处理 ,根据患者治疗前后 VAS变化率来对患者的疼痛缓解情况进行评估 ,VAS变化率≥ 75 %为显效 ,≥ …     

Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain. A pilot study with 20 terminally ill cancer patients

This pilot study evaluated the efficacy and side effects of a combination of initial patient-controlled analgesia (PCA) for dose-finding with transdermal fentanyl administration. Twenty inpatients, requiring strong opioids for severe cancer pain, received intravenous fentanyl on an on-demand basis over a 24-h period. The amount of fentanyl administered was then used as a guideline for selecting a suitable transdermal therapeutic system (TTS) on the 2nd day, which remained in place for 3 days. The size of 2nd TTS, being used from day 5 to 7, was adjusted according to the amount of supplementary intravenous fentanyl doses on day 3. From day 4 to 7 intravenous fentanyl was stopped, and subcutaneous morphine was made available as a rescue medication. A standardized adjuvant medication was allowed. Pain intensity, pain relief, quality of sleep, mood, general state of health, activity, mobility, rescue morphine consumption and side effects were assessed using a diary after baseline pain and symptoms were recorded. Vital functions were monitored and fentanyl plasma levels were measured daily in 15 patients.

The use of TTS fentanyl in combination with initial dose titration using PCA gave rapid and statistically significant pain relief. Patient compliance and acceptance were excellent. In the absence of severe side effects the main complaints were dryness of the mouth and constipation.

Increasing pain intensity and increasing supplementary morphine requirements as well as decreasing plasma fentanyl levels on day 7 may indicate that conversion ratios from intravenous to transdermal administration should be increased or that TTS should be changed earlier. Special indications for this combination may be in patients with dysphagia or vomiting, where pain management could be facilitated.     

A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.

Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs.The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.     

芬太尼透皮贴剂在普外术后镇痛中的应用

目的探讨芬太尼透皮贴剂（5 mg/贴）对普外科术后病人的镇痛效果及安全性。方法分别选择住院接受腹腔镜下胆囊切除术、痔外剥内扎术及甲状腺次全切或部分切除术的病人各20例,各组再设实验组及对照组各10例。观察实验组在应用芬太尼透皮贴剂后,术后疼痛是否较对照组有所减轻,以及副反应发生情况。结果应用芬太尼透皮贴剂组病人术后疼痛明显较对照组减轻,术后副反应发生率比较差异无统计学意义。结论应用芬太尼透皮贴剂于普外术后镇痛,是一种方便、有效且安全的方法。     

How chronic pain patients cope with pain: Relation to treatment outcome in a multidisciplinary pain clinic

One hundred male and 100 female chronic pain patients in a multidisciplinary pain clinic completed a 34-item Pain Coping Questionnaire (PCQ). Factor analysis identified four pain coping factors: self-management, helplessness, social support, and medical remedies. Multiple-regression analyses were conducted to determine the relation between PCQ factors and measures of adjustment at admission to the pain program as well as admission to discharge changes in adjustment measures. The following concepts relevant to coping with chronic pain were defined: cognitive strategies, self-efficacy, helplessness, catastrophizing, and cognitive distortion. Suggestions were made for integrating these concepts in the development of scales for assessing strategies for coping with chronic pain.     

慢性腰痛患者功能障碍与生存质量的研究

目的:探讨慢性腰痛(CLBP)患者功能障碍与生存质量(QOL)的关系。方法:选取CLBP患者60例(男22例,女38例),分别采用目测类比定级法(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)腰痛评估表及健康状况调查问卷(SF-36)评定患者的疼痛程度、功能状况及QOL。结果:男性CLBP患者总体健康(GH)和心理健康(MH)评分明显高于女性(P0.05)。SF-36及其中躯体功能(PF)、生理职能(RP)、躯体疼痛(BP)、患者自控镇静(PCS)项的评分与VAS和ODI评分呈负相关(P0.05),与JOA评分呈正相关(P0.05)。GH、活力(VT)、社会功能(SF)及精神健康总评(MCS)项的评分与ODI评分呈负相关(P0.05),与JOA评分呈正相关(P0.05)。结论:腰痛及功能障碍在一定程度上影响CLBP患者的QOL,应加以干预,使其能够正确对待疾病,提高QOL。     

青年慢性下腰痛患者腰背肌耐力比较研究

目的 :研究青年下腰痛患者腰背肌耐力的变化。方法 :应用CYBEX - 6 0 0 0型等速测试训练系统和肌电图测试腰痛组 (n =4 0 )和正常组 (n =4 0 )的腰背肌耐力指标 ,进行两组间比较。结果 :腰痛组腰背肌耐力比与正常组无差异 (P >0 .0 5 ) ;腰痛组腰背肌肌电图波幅低于正常组 (P <0 .0 5 )、时程大于正常组 (P <0 .0 5 ) ,腰痛组腰背肌肌电图波幅随时间衰减程度大于正常组 (P <0 .0 5 )、时程随时间延长程度大于正常组 (P <0 .0 5 )。结论 :青年下腰痛患者存在着明显的腰背肌静态耐力下降 ,腰背肌耐力比与下腰痛关系并不密切。     

Outcome of intrathecal opioids in chronic non-cancer pain

Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). At the time of follow-up, mean pain relief was 60% with 74% of patients (36 of 49) reporting increased activity levels. Oral medication intake was significantly reduced (Medication Quantification Scale Score prior to implantation 31.0+/-2.6 and at follow-up 12.7+/-1.4; n= 48; p< 0.0001). These gains were not accompanied by a change in work status (43 of 50 working age patients not working at follow-up). There were frequent reports of opioid side-effects, including sexual dysfunction and menstrual disturbance. Technical complications occurred with the drug administration device, most often catheter related, requiring at least one further surgical procedure in 32 patients (40%). Patient satisfaction with intrathecal opioids was high, with 45 of 51 (88%) reporting satisfaction. Mean intrathecal morphine dose increased from 9.95+/-1.49 mg/day (mean+/-SEM) at 6 months to 15.26+/-2.52 mg/day 36 months after initiation of therapy. Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.     

Sexuality and sexual adjustment of patients with chronic pain

Purpose: To describe sexual functioning and its relationship with psychological measures in chronic pain patients.

Method: It is a self report survey with a convenience sample. Seventy consenting chronic pain patients responded to a questionnaire. Mean age was 49-9 years (range 29–74); mean pain duration was 146–7 months (range 6–624). Participants endorsed a wide variety of pain conditions.

Instruments used: (1) Derogatis Inventory of Sexual Functioning; (2) Multidimensional Pain Inventory; (3) Center for Epidemiological Studies Depression Scale; (4) Multidimensional Health Locus of Control; (5) Hopkins Symptom Check List; (6) Vanderbilt Pain Management Inventory; (7) Coping Strategies Questionnaire.

Results: Sixty-six per cent of patients were interested in sex, 50% were satisfied with current sexual partner and 20% considered current sexual life to be adequate. Over 70% fantasized at least once a month. Only 44% experienced normal arousal during intercourse; 33% practiced masturbation and 47 % were involved in sexual intercourse or oral sex at least once a month. The majority were dissatisfied with orgasmic activities. No relationship was found between pain severity, duration, frequency and sexual functioning. A relationship was found between disability status, age and several psychological variables and various domains of sexual functioning.

Conclusions: Sexual problems are common in chronic pain patients. Patients who reported symptoms of depression and distress had more sexual problems.     

Opioids in chronic non-cancer pain, indications and controversies.

The use of opioid analgesics for long term management of chronic non-cancer pain is now an accepted, although still a controversial medical practice. In some well selected patients with long-lasting or recurrent pain, severe enough to markedly reduce their quality of life, and for whom no other more effective and less risky therapy is available, opioid analgesics may reduce intensity of pain, increase functioning and improve quality of life for prolonged periods. The type of pain and pain history of the patients do not predict reliably the chance of long term success or risk of complications from opioid therapy. However, the outlook for successful long term opioid therapy is better in a patient with a stable psychosocial situation having nociceptive type pain that is markedly relieved by a moderate dose of a long lasting oral or transdermal opioid, than a patient from a complex and unstable psychosocial background having neuropathic type pain that is relieved only partly by a higher dose of a potent opioid. When a patient is managed by a multidisciplinary team, the compliance is better and risk of loss of control and complications are less than when a single doctor is managing the patient. The evidence base for this type of pain management is meagre because the needed randomized controlled trials, which ideally should last for several years, have not been performed. Therefore a number of national and international guidelines are being published, recommending experts' opinion on appropriate use and responsible follow-up of long term treatment with opioids for chronic non-cancer pain.