Continuous epidural narcotic analgesia for intractable pain due to malignancy

Eighty consecutive cancer patients with severe pain, uncontrolled by conventional narcotic analgesics, received a 2-mg test dose of morphine epidurally. Thirty-four of them had significant pain relief and were thus selected to receive continuous treatment. This consisted of 2-6 mg of morphine administered every 8-24 hours through an indwelling epidural catheter. The duration of treatment was from 1 to 28 weeks with a median of 4 weeks. Twenty-five (76%) of the patients experienced complete relief of pain, while nine had only a partial analgesic response. Complications were minimal. No sepsis, hypotension, or respiratory depression occurred. It is recommended that cancer patients with intractable pain will be selected for continuous epidural analgesia by evaluating their response to a test dose of epidural morphine.     

Analgesic activity of high-dose intravenous calcitonin in cancer patients with bone metastases

We undertook a prospective, nonrandomized study with the objective to evaluate the efficacy of salmon calcitonin (sCT) in controlling pain secondary to bone metastases. Our study population consisted of 45 cancer patients with bone metastases (26 men) with a mean age of 64 years (range, 48-70) who had completed chemotherapy, hormonal therapy and radiation therapy at least 30 days prior to enrollment in the study, and had intractable pain despite the use of common analgesics (acetaminophen, nonsteroidal anti-inflammatory agents, opioids) and bisphosphonates. The study medication was a 300-IU dose of sCT administered intravenously daily for 5 consecutive days and repeated every two weeks until no response was noticeable. The analgesic efficacy of sCT was evaluated by means of Huskisson's visual analogue scale and Keele's pain scale; the daily consumption of analgesic drugs and performance status were also monitored. None of the patients managed to completely discontinue the use of other analgesics, but 5 patients (11% of the total number) had an analgesic response that lasted 4 weeks and less than 5% of the patients continued to respond for 6 weeks. No significant side effects were observed. Our data show that intravenous calcitonin administered in a relatively high dose has a very limited therapeutic potential as an adjuvant analgesic for a short period of time in selected cancer patients with bone metastases.     

舒芬太尼腰硬膜联合治疗重症癌痛的临床疗效观察

目的：观察舒芬太尼腰硬膜联合治疗重症癌痛的临床效果。方法选取晚期癌痛患者48例,随机分为观察组和对照组,各24例。观察组给予腰硬膜联合治疗,以舒芬太尼和罗哌卡因先行蛛网膜下隙注射,再行硬膜外镇痛;对照组给予单纯硬膜外镇痛。比较2组患者镇痛效果包括治疗前、用药后30 min、持续性、暴发性VAS评分以及总体满意度。结果2组患者治疗前、用药后30 min、持续性VAS评分比较差异无统计学意义（P＞0．05）,观察组暴发性VAS评分明显低于对照组（P＜0．05）;观察组总体满意度明显高于对照组（P＜0．05）。结论舒芬太尼腰硬膜联合治疗重症癌痛可有效降低暴发痛VAS评分,提高患者总体满意度,值得临床推广应用。     

羟考酮控释片治疗中重度肺癌疼痛的临床观察

目的：观察盐酸羟考酮控释片（奥施康定）治疗中重度肺癌疼痛的疗效,不良反应及患者生活质量改善情况,同时观察不同心理状态对疼痛程度和镇痛疗效的影响.方法：应用盐酸羟考酮控释片治疗76例中重度肺癌疼痛患者,盐酸羟考酮控释片起始剂量5mg/12h或10mg/12h,根据疼痛缓解程度调整剂量,直至达到满意镇痛效果,对其镇痛疗效,不良反应进行观察和评估.采用生活质量量表EORTCQLQ-C30（V3.0）中文版对肺癌疼痛患者镇痛治疗前后的生活质量进行评估.观察不同心理状态对疼痛强度和镇痛效果的影响.结果：入组的76例患者中,有74例可评价疗效和安全性,其中67例（90.5%）达到满意的疼痛缓解,平均达有效维持剂量时间为2.4天.消极悲观者疼痛程度重、镇痛效果差,积极乐观者疼痛程度轻、镇痛效果佳.主要不良反应为便秘、恶心呕吐、头晕、排尿困难、嗜睡.在疼痛缓解的同时,肺癌疼痛患者的生活质量得到了明显改善.结论：心理状态与疼痛程度和镇痛疗效密切相关;盐酸羟考酮控释片治疗中重度肺癌疼痛安全有效,能明显改善肺癌疼痛患者的生活质量.     

盐酸羟考酮控释片阴道给药治疗癌性疼痛的临床研究

背景与目的：盐酸羟考酮控释片是治疗中重度癌性疼痛的强阿片类口服镇痛药,部分患者由于持续的恶心、呕吐、意识障碍或吞咽困难等,常使其口服应用受到限制。本研究目的是观察盐酸羟考酮控释片阴道给药方式治疗中重度癌性疼痛的疗效及不良反应,为口服药物困难的女性患者提供新选择。方法：36例不能口服药物中重度癌痛女性患者采用盐酸羟考酮控释片阴道给药方式治疗,以往未使用阿片类止痛药物者,初始盐酸羟考酮控释片剂量为10mg,每12h用药一次,剂量滴定参考口服给药方法：对凶不能继续口服盐酸羟考酮控释片而改用阴道给药方式者,继续原来剂量阴道给药。结果：36例患者中完全缓解6例,明显缓解20例,中度缓解和轻度缓解各4例,未缓解2例;中度以上疼痛缓解率为83．3％。中位起效时间为49min;中位镇痛时间为13．8h。主要不良反应为阴道烧灼感（9例,25．0％）,无因不良反应而中止治疗者。结论：盐酸羟考酮控释片阴道给药方式安全、有效、方便,在口服药物困难的女性患者是一种可选择的给药方式。     

奥施康定治疗中重度癌痛疗效观察

目的:观察奥施康定治疗中重度癌痛的疗效及不良反应。方法:奥施康定起始剂量10mg/12h,根据疼痛缓解程度调整剂量,评价镇痛效果、KPS评分及不良反应。结果:平均镇痛起效时间41分钟,平均镇痛时间12.6h,日平均剂量69.03mg。31例中重度癌痛患者,轻度缓解1例(3.23%),中度缓解4例(12.90%),明显缓解20例(64.52%),完全缓解6例(19.53%),中度以上疼痛缓解率96.77%。KPS评分:19例(61.29%)升高,9例(29.03%)稳定,3例(9.68%)病情恶化死亡。不良反应主要为便秘11例(35.48%)。结论:奥施康定治疗中重度癌痛时,起效快,镇痛效果满意,副反应轻,服用安全。     

CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛的临床分析

目的:探讨CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛的临床镇痛效果。方法:选取2016年6月至2018年6月70例晚期胰腺癌顽固性疼痛患者为研究对象,按随机数字表法分为对照组和观察组各35例。对照组:采用芬太尼透皮贴剂4.125 mg/贴×2/72 h 外用+加巴喷丁胶囊 200 mg po 3/d;观察组:采用CT引导下腹腔神经丛射频热凝术,射频治疗参数设置为:3 min,70 ℃。评价两组晚期胰腺癌顽固性疼痛患者镇痛效果。结果:治疗后3 d、6 d、21 d、60 d两组患者VAS评分均呈下降趋势（P<0.05),且观察组治疗后各时间点VAS评分均低于对照组,疼痛缓解率均高于对照组,差异有统计学意义（P<0.05）。两组患者治疗前躯体功能评分、情绪功能评分、社会功能评分、总健康状况评分差异均无统计学意义（P>0.05）。治疗后3 d、6 d、21 d、60 d观察组较对照组躯体功能评分、情绪功能评分、社会功能评分呈下降趋势,总健康状况评分呈上升改变,两组差异有统计学意义（P<0.05)。治疗前1 d两组患者血清炎性因子TNF-α、IL-6、CRP含量比较差异无统计学意义（P>0.05）。治疗后1 d、3 d,观察组血清TNF-α、IL-6、CRP含量均明显低于对照组,两组差异有统计学意义（P<0.05)。结论:CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛镇痛效果确切,具有操作简单、创伤小、见效快、安全有效等优势。     

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。      

病人自控式镇痛泵静脉泵入吗啡治疗难治性癌痛的临床效果观察

目的:观察使用病人自控式镇痛泵静脉泵入吗啡治疗难治性癌痛的临床效果。方法:筛选难治性癌痛患者32例,采用PCA泵静脉泵入吗啡注射液止痛治疗。回顾性分析上述病例患者的临床特征,观察镇痛过程,评价PCA泵的镇痛疗效和安全性。结果:多数难治性癌痛患者对吗啡的需求量增加,使用PCA泵静脉泵入吗啡能快速及有效的镇痛,患者的疼痛程度明显减轻,生活质量显著改善,无严重不良反应发生。结论:使用PCA泵治疗难治性癌痛,合理控制吗啡使用剂量,操作简单,提高患者用药的依从性,能够快速、及时和有效镇痛。     

Drug delivery for intractable cancer pain. Use of a new disposable parenteral infusion device for continuous outpatient epidural narcotic infusion

Administration of narcotic analgesics through the epidural route has proven useful for treating pain of acute and chronic nature. This route of narcotic administration is frequently chosen for cancer patients with intractable pain that may be refractory to treatment by conventional oral or parenteral therapy. Implantable constant infusion devices have been commonly described as an alternative drug delivery system for this type of patient. This case report describes the use of the Travenol Infusor (Travenol Laboratories Inc., Deerfield, Illinois) an external, lightweight, disposable, drug delivery device for delivering continuous epidural morphine infusion to a patient with severe cancer pain. The patient has achieved stable pain relief for greater than 8 months without hospital admission for pain control, or management of complications due to the drug delivery system. The Travenol Infusor may prove to be an alternative drug delivery system for patients requiring continuous epidural narcotic infusion.     

Electrical stimulation of the brain for relief of intractable pain due to cancer

Seventeen patients with intractable pain due to progressive malignancies were treated by electrical stimulation of the brain after more conventional pain therapies applied in the University of California, Los Angeles Cancer Pain Clinic had failed. Electrodes were stereotactically implanted under local anesthesia in the periaqueductal grey (PAG) or periventricular grey (PVG) in 11 patients. In six patients electrodes were placed in both PAG-PVG targets and in the sensory thalamic nuclei. Thirteen of the 17 patients achieved virtually total pain relief and 2 others achieved partial pain relief. At the hospital discharge only 4 of 17 patients required narcotic analgesics for pain relief. Follow-up periods ranged from 1 to 21 months and 6 patients remain alive. Fourteen patients eventually required narcotics for pain relief, usually in the terminal few weeks of their lives. Pain relief was achieved in spite of the fact that all patients were tolerant to large doses of systematically or intraspinally administered narcotics at the time of electrode placement. No complications related to brain stimulation were identified. Brain stimulation is a safe and effective method for treatment of intractable pain due to malignancy in certain patients.     

奥施康定治疗中重度癌痛疗效观察

Objective： To evaluate the analgesic efficacy as well as adverse effects of OxyContin for the treatment of moderate to severe cancer pain. Methods： OxyContin was administered at an initial dose of 10 mg every 12 h and titrated upwards according to the extent of pain relief. The analgesic effect, Karnofsky performance status （KPS） scale as well as adverse effects were investigated. Results： The mean onset time and duration of analgesic effect was 41 min and 12.6 h, respectively, with the daily average dose of 69.03 mg. Among all the 31 patients who had suffered moderate to severe pain, slight pain relief was achieved in one patient （3.23 %）. Moderate, obvious and complete pain relief were achieved in 4 （12.90 %）, 20 （64.52 %） and 6 （19.53%）, respectively. KPS was elevated in 19 （61.29%） and stable in 9 （29.03%） patients after administration of OxyContin. 3 （9.68%） patients were died of disease deterioration. Main adverse effect was constipation in 10 cases （32.26%）. Conclusion： OxyContin was effective in the treatment of moderate to severe cancer pain, with rapid onset, good analgesic performance, mild adverse effect and safety profile.     

奥施康定治疗中重度癌痛临床观察

目的：观察盐酸羟考酮控释片（奥施康定）治疗中重度癌痛的疗效及不良反应。方法：采用开放试验方法,对49例中重度癌痛患者进行治疗。奥施康定起始剂量10mg／12h,根据疼痛缓解程度调整剂量,评价镇痛效果、KPS评分及不良反应。结果：49例中重度癌痛患者,平均镇痛时间12．45h。总有效率89．80％,中度疼痛组有效率93．75％,重度疼痛组有效率87．88％。KPS评分：28例（57．14％）升高,19例（38．78％）稳定,2例（4．08％）病情恶化死亡。不良反应主要为便秘7例（14．29％）。结论：奥施康定治疗中重度癌痛疗效确切,不良反应轻,服用安全。     

Analgesic Efficacy and Pharmacokinetic Evaluation of Meperidine and Hydroxyzine, Alone and in Combination

As part of a study to evaluate the analgesic efficacy of meperidine and hydroxyzine, alone and in combination, a double-blind complete crossover study of meperidine (50 mg IM), hydroxyzine (100 mg IM), meperidine (50 mg IM) plus hydroxyzine (100 mg IM), and saline placebo was conducted. Thirty patients with chronic moderate to severe pain due to metastatic cancer were evaluated as to pain relief following administration of all four study medications. All of the treatment groups showed statistically significant analgesic activity as compared to placebo. Hydroxyzine provided sustained pain relief to six hours, whereas meperidine produced analgesia up to two hours. The combination produced additive analgesia only during the first 2 hr. The pharmacokinetics of meperidine and hydroxyzine were compared to observed analgesia. Significant correlation between serum drug levels of meperidine and hydroxyzine and pain relief resulted and the serum levels of meperidine and hydroxyzine necessary for analgesia were calculated to be 0.10-0.15 mg/ml and 60-70 ng/ml; respectively. The observed analgesia of the meperidine/hydroxyzine combination was correlated with the analgesia of the individual agents and the limited additive analgesia observed with the addition of meperidine to hydroxyzine does not justify the added toxicity of the narcotic.     

硫酸吗啡控释片对晚期癌痛镇痛效果临床试验观察

应用吗啡控释片（ＣＲＭＳ）对晚期癌症伴有中、重度疼痛患者进行镇痛效果和安全性考察。试验组ＣＲＭＳ３０ｍｇｑ１２ｈＰｏ，２５例。对照组硫酸吗啡普通片ＩＲＭＳ１０ｍｇｑ４ｈＰｏ，３１例。均连续服用６天，采用总疼痛强度差、总疼痛缓解度、总镇痛分为镇痛指标，结果表明ＣＲＭＳ和ＩＲＭＳ的镇痛效果无显著性差异。ＣＲＭＳ的主要不良反应如头晕、恶心、呕吐发生率与ＩＲＭＳ无显著性差异。Ｐ＜０．０１，ＣＲＭＳＶＳＩＲＭＳ但前者减少了服药次数。４．２ＣＲＭＳ与ＩＲＭＳ常规给药后，一般在２～３天可达到有效稳定镇痛状态（见表６）。４．３ＣＲＭＳ与ＩＲＭＳ在试验中，均未发现呼吸抑制及血压降低，对心、肝、肾功能未见明显损害。ＣＲＭＳ的毒副作用主要表现恶心、呕吐，发生率第１天达４６．２％和２０．８％，以后逐日下降。分析认为与起始剂量稍高有关外还可能与黄种人对吗啡的敏感性有关。华人表现了明显的胃肠道反应［１］。４．４本试验组５３人连续服药６天表明其耐受性不是主要问题。参考文献     

曲马多、吗啡单独及联合应用于腹部肿瘤术后镇痛效果比较

背景与目的：吗啡用于术后镇痛时虽然疗效肯定,但副作用较多。曲马多为一新合成的μ-阿片受体激动剂,其用于硬膜外镇痛时疗效、副作用等报道不多。本研究拟比较曲马多、吗啡及其联合用于膜外术后镇痛时的疗效及副作用。方法：120例腹部肿瘤手术病人随机分为曲马多组（T组,n=40)、吗啡组（M组,n=40)和曲马多、吗啡联合组（T＋M组,n=40)行硬膜外术后48h持续、恒速镇痛。镇痛药配方：T组为曲马多12mg/kg 0.125%布比卡因100ml,M组为吗啡0．12mg/kg 0.125%布比卡因100ml,T＋M组为曲马多6mg/kg 吗啡0．06mg/kg 0.125%布比卡因100ml。分别记录三组病人术后VAS评分、BCS舒适评分、病人满意度评分（GSS评分）及副作用。结果：三组VAS评分无差异（P＞0．05）,VAS＞5分者,T组显著多于M组及T＋M组（P＜0．05）。BCS及GSS评分T＋M组显著优于T组及M组（P＜0．05）。恶心、呕吐发生率T＋M组显著低于M组（P＜0．05）。结论：曲马多术后硬膜外镇痛疗效与吗啡近似,但波动较大,用药剂量应个体化。曲马多、吗啡联合用药可获得满意的镇痛效果,显著减少恶心、呕吐等副作用的发生。     

Use of TTS fentanyl as a single opioid for cancer pain relief: a safety and efficacy clinical trial in patients naive to mild or strong opioids.

BACKGROUND: Up to now, a transdermal therapeutic system (TTS) of fentanyl has been applied to cancer patients on opioid analgesics previously treated with mild opioids or morphine. The aim of this study was to investigate the efficacy and safety of TTS fentanyl (patch) administration as an analgesic to patients treated with opioid analgesics for moderate-to-severe cancer pain, with immediate-release oral morphine only as rescue medication. The prior analgesic medication of the patients did not include mild or strong opioids. METHODS: The study group consisted of 113 patients (54 men and 59 women; age range: 21-87 years, mean +/- SD 61.3 +/- 14.84 years) with undertreated chronic cancer pain. The study period was 42 days. The patients were hospitalized for the first 3 days of the study; thereafter they were transferred to their home for the rest of the study. Daily cards were completed, noting their pain score (0-10 VAS), nausea, vomiting, constipation, skin reactions, dizziness or any other complaints. Vital signs were also recorded. Data assessments were made at baseline, on days 1, 2 and 3 (during hospitalization) and thereafter on days 7, 14, 21, 28, 35, and 42 after hospital discharge. The initial TTS fentanyl delivery rate was chosen depending on the patient's analgesic requirements. All patients were given an oral morphine solution (5-10 mg), every 4-6 h, for the first 12 h, as rescue medication. RESULTS: Baseline pain score was between 6 and 10 (mean +/- SD 7.1 +/- 1.7). The initial TTS fentanyl delivery rate was between 25 and 50 microg/h (mean +/- SD 36.5 +/- 15.7). On day 3, 95 patients (84%) reported a pain score < or = 3 (mean +/- SD 0.5 +/- 0.8), 14 patients (12.4%) a pain score of 4 and 4 patients (3.5%) of 5-8. No adverse effects suggesting the discontinuation of the study were reported. From day 7 until the completion of the study, the mean pain score was between 1.3 and 0.16 while the TTS fentanyl delivery rate on day 42 was between 25 and 400 microg/h (mean +/- SD 122.1 +/- 81.2 microg/h). CONCLUSION: Analgesic treatment with TTS fentanyl used as a single opioid is effective and safe for cancer pain relief, given that is cautiously applied, in patients requiring strong opioid analgesics even if they were naive to strong or mild opioids.     

美施康定治疗中重度癌痛的临床观察

目的评价美施康定治疗癌性疼痛的效果并观察其毒副作用。方法1995.11～1998．6，103例病人接受美施康定治疗。男性78例，女性25例；年龄32～81岁（中位年龄58岁）。73例病人同时接受其他的抗癌姑息冶疗，其中化疗31例，放疗10例，内分泌治疗6例，抗骨溶解治疗（博宁、阿可达）14例，化疗与放疗相结合治疗12例。肿瘤病人以肿痛为主，其它有肝癌、乳癌、鼻咽癌和消化道肿瘤病人。结果止痛的有效率为8835％（91／103），平均止痛剂量为80mg／天，平均初始剂量和最大剂量分别为45．5mg／天／112．8mg／天。疼痛平均缓解时间为9周。21．39％（21/103）病人增加剂量（其中19例为单独止痛药运用组），16.51％（17／103）需要减少剂量（其中16例为联合其他抗癌治疗组）。主要副作用是便秘和恶心呕吐。结论每天两次中等剂量的美施康定治疗癌性疼痛是相当有效的．而且副作用轻，可以耐受，与其他抗癌姑息治疗联用有协同增效作用。     

Percutaneous cementoplasty of lytic metastasis in left acetabulum

Minimally invasive procedures such as percutaneous cementoplasty can provide immediate pain relief and can restore mechanical stability for patients with bone metastases who are not candidates for surgery or who show resistance to radiotherapy or analgesic treatment. Here, we examine a case of percutaneous cementoplasty to treat a lytic lesion of the acetabulum from breast cancer. Good filling was observed, and no complications occurred. A research assistant recorded the patient's scores on the Karnofsky Performance Scale, Townsend Functional Assessment Scale, and Brief Pain Inventory before surgery and at days 1, 2, and 4 and weeks 1, 2, and 4 post-procedure. Improvement in pain and walking ability was demonstrated within the first 48 hours of treatment, and that improvement remained constant throughout follow-up. These findings echo the literature, in that percutaneous cementoplasty provides immediate and long-term pain relief with few complications. We recommend that percutaneous cementoplasty be used as an additional tool for palliative treatment of patients with bone metastases.