健康指导对奥施康定治疗中、重度癌痛治疗效果的影响

目的观察健康指导对奥施康定治疗中、重度癌痛止痛效果及不良反应的影响。方法 94例中、重度癌痛患者在服用奥施康定同时,结合正确的止痛理念指导、正确服药指导、不良反应的预防指导及指导家属对患者提供必要的家庭支持。结果完全缓解（CR）＋明显缓解（PR）90例,轻度缓解（MR）4例,不良反应有便秘、恶心呕吐、嗜睡、头晕、排尿困难等,发生率低。结论奥施康定结合正确的健康指导能有效控制癌性疼痛,改善生活质量,且不良反应轻微,发生率低。     

奥施康定与美施康定控制中重度癌痛临床疗效比较

目的比较羟考酮控释片与吗啡控释片控制癌痛的疗效和副作用。方法81例患者随机分为两组,奥施康定组36例,美施康定组45例,分别就其疗效、生活质量改善情况以及不良反应等方面进行评价。结果奥施康定与美施康定治疗中重度癌痛的显效率分别为83．7％、82．2％,疗效相当,两组生活质量改善情况治疗前后均无差异。但便秘、恶心、呕吐、嗜睡等不良反应方面奥施康定组明显低于美施康定组。结论两药治疗中重度癌痛疗效可靠,生活质量均可得到改善,但奥施康定不良反应发生率较低,用于中重度癌痛安全可靠。     

奥施康定和芬太尼透皮贴治疗中-重度癌痛的临床观察

目的对比观察奥施康定(盐酸羟考嗣控释片)和芬太尼透皮贴治疗慢性中、重度癌痛的疗效和不良反应。方法 84例中、重度癌痛患者随机分为奥施康定治疗组或芬太尼透皮贴组。奥施康定组初始剂量10mg/12h,正在用吗啡镇痛者,按照吗啡0.5剂量换算。芬太尼透皮贴组初始剂量为25μg/h,正在用吗啡镇痛者,按照芬太尼透皮贴(μg/h)=每日吗啡剂量(mg)×0.5换算。根据疼痛情况调整剂量,每位患者至少治疗两周,同时进行疼痛强度、生活质量评分及不良反应观察。结果奥施康定组41例疼痛缓解率为92.68%;多瑞吉组43例为93.02%。两组患者生活质量均明显提高,主要不良反应为便秘。结论奥施康定和多瑞吉治疗中、重度癌痛疗效均显著,不良反应较少,能显著改善癌症患者的生活质量。     

盐酸羟考酮控释片治疗中重度癌性疼痛46例

目的 观察盐酸羟考酮控释片(奥施康定)在不同类型中重度癌性疼痛中的治疗作用及不良反应,评价奥施康定在癌症三阶梯止痛中的地位.方法 46例中重度癌性疼痛患者,按起始剂量10 mg/12 h给予奥施康定口服,根据疼痛缓解程度调整剂量,评价镇痛效果及不良反应.结果 46例患者镇痛起效时间30～75 min,镇痛时间8.5～17.5 h,日口服剂量(110.5±10.7)mg;轻度缓解1例(2.2%),中度缓解3例(6.5%),明显缓解20例(43.5%),完全缓解22例(47.8%),疼痛缓解率97.8%(45/46).32例(69.6%)生活质量改善,9例(19.6%)生活质量稳定.结论 奥施康定对于不同类型癌性疼痛疗效均好,可作为治疗中重度癌性疼痛的首选药物之一.     

奥施康定和芬太尼透皮贴治疗中一重度癌痛的临床观察

目的对比观察奥施康定（盐酸羟考嗣控释片）和芬太尼透皮贴治疗慢性中、重度癌痛的疗效和不良反应。方法84例中、重度癌痛患者随机分为奥施康定治疗组或芬太尼透皮贴组。奥施康定组初始剂量10mg／12h,正在用吗啡镇痛者,按照吗啡0．5荆量换算。芬太尼透皮贴组初始剂量为25μg／h,正在用吗啡镇痛者,按照芬太尼透皮贴（μg／h）=每日吗啡剂量（mg）×0．5换算。根据疼痛情况调整剂量,每位患者至少治疗两周,同时进行疼痛强度、生活质量评分及不良反应观察。结果奥施康定组41例疼痛缓解率为92．68％;多瑞吉组43例为93．02％。两组患者生活质量均明显提高,主要不良反应为便秘。结论奥施康定和多瑞吉治疗中、重度癌痛疗效均显著,不良反应较少,能显著改善癌症患者的生活质量。     

奥施康定用于慢性癌性中重度疼痛的疗效观察

目的研究观察针对奥施康定治疗慢性癌性中重度疼痛的临床疗效及用药安全性。方法选取本院肿瘤科室2014年6月到2015年12月收治癌症患者76例作为研究对象,76例患者均为首次服用奥施康定。初始计量为10mg/12h,根据患者自身情况给予不同程度的加减,连续服用药物一个月后,研究人员对其疼痛程度、疼痛治疗效果、服用后不良反应率进行观察对比。结果 76例患者治疗一个月后的总显效率为94.73%,起效平均时间为(24.71±3.88)分,平均镇痛时间为(10.89±2.03)小时。结论对于慢性癌性中重度疼痛患者给予奥施康定药物可降低患者疼痛指数,增加患者服用的安全性,对患者临床疗效具有显著作用。     

羟考酮缓释片用于癌痛患者滴定治疗的可行性分析

目的：探讨羟考酮缓释片用于癌痛患者止痛滴定的可行性。方法：48例中重度疼痛的阿片未耐受癌症患者,中位年龄74.5岁,分为A（中度疼痛）、B（重度疼痛7～8分）、C（重度疼痛9～10分）三组,盐酸羟考酮缓释片初始剂量分别为10mg、10mg、20mg联合短效吗啡针剂5mg～10mg,根据患者疼痛情况及爆发痛治疗情况于12h和24h调整奥施康定的剂量。评估24h滴定完成率（疼痛评分3分以下）以及1h、12h、24h疼痛明显缓解率、不良反应及生活质量的变化。结果：24h评估时95.8%的患者完成滴定,疼痛评分降到3分以下。1h、12h、24h疼痛明显缓解率分别为66.7%、77.1%和95.8%。预防治疗可显著降低恶心、呕吐、便秘不良反应。止痛治疗后睡眠质量明显改善。结论：奥施康定用于阿片未耐受中重度癌痛患者滴定,有效、简便、快速。     

盐酸羟考酮缓释片治疗晚期肿瘤中重度疼痛的临床观察

目的 观察盐酸羟考酮缓释片(奥施康定)在晚期肿瘤中重度疼痛的治疗效果、不良反应及生活质量改善情况.方法 应用盐酸羟考酮缓释片治疗80例晚期肿瘤患者的中重度疼痛,全面评估患者疼痛,确定好初始剂量,根据患者疼痛控制情况调整患者用药剂量,从而达到有效的镇痛效果,并观察患者用药前后生活质量改善情况及用药后患者不良反应的情况.结果 80例晚期肿瘤中重度疼痛患者,最终滴定剂量60-480mg/天,治疗后疼痛评分在3分以下(疼痛达满意控制)的患者71例,占88.7%,经镇痛治疗后患者食欲增加,睡眠明显改善,生活质量提高.在所有不良反应中,便秘最常见(发生率为15.0%),其次是恶心、呕吐、头晕,无呼吸抑制及"成瘾"的发生.结论 盐酸羟考酮缓释片在治疗晚期肿瘤中重度疼痛方面安全有效,副作用小,生活质量明显提高,适合慢性癌痛患者长期使用.     

盐酸羟考酮控释片联合氟比洛芬酯治疗癌痛疗效观察

目的观察盐酸羟考酮控释片（奥施康定）联合氟比洛芬醅（凯纷）治疗中重度癌痛的疗效。方法选择43例中重度癌痰忠者进行治疗，记录治疗前后疼痛强度、生活质量评分及不良反应。结果盐酸羟考酮控释片治疗中重度癌痛疗效确切，镇痛效果明显。治疗后生活质量明显好转。结论盐酸羟考酮控释片（奥施康定）联合氟比洛莽醋（凯纷）能有效控制癌性疼痛’改善生活质量。     

盐酸羟考酮控释片联合氟比洛芬酯治疗癌痛疗效观察

目的 观察盐酸羟考酮控释片(奥施康定)联合氟比洛芬酯(凯纷)治疗中重度癌痛的疗效.方法 选择43例中重度癌痛患者进行治疗,记录治疗前后疼痛强度、生活质量评分及不良反应.结果 盐酸羟考酮控释片治疗中重度癌痛疗效确切,镇痛效果明显.治疗后生活质量明显好转.结论 盐酸羟考酮控释片(奥施康定)联合氟比洛芬酯(凯纷)能有效控制癌性疼痛,改善生活质量.     

奥施康定治疗中晚期胃癌疼痛效果的临床观察

目的：评估奥施康定（OxyContin）用于胃癌中晚期患者的镇痛效果,同时观察奥施康定对于胃癌患者生活质量的影响。方法：选择68例胃癌中晚期患者给予奥施康定进行镇痛处理。初始剂量为10mg/12h。在治疗期间,用药剂量根据疼痛缓解程度进行调整,疗程持续15天以上。同时,对服药后的不良反应以及患者生活质量进行观察并记录。结果：奥施康定对中、重度胃癌疼痛的有效率分别为100%和92.0%,能够显著改善患者的睡眠质量和精神状态,同时不良反应较轻。结论：奥施康定能够有效控制中晚期胃癌疼痛,同时明显提高患者的生活质量。     

芬太尼透皮贴剂治疗中重度癌痛的疗效观察及安全评估

目的观察芬太尼透皮贴剂治疗中重度癌痛的近期疗效和不良反应。方法内脏痛、骨转移痛、侵犯和压迫神经痛、皮肤黏膜痛等慢性癌性疼痛42例,应用芬太尼透皮贴剂治疗,记录疗效及治疗期间便秘、恶心呕吐、嗜睡、头晕、呼吸抑制等不良反应出现的情况。结果总有效率为90．4％（38／42）,不良反应有便秘4例（9．5％）,恶心呕吐4例（9．5％）,其他有嗜睡、头晕、胃部不适、呼吸抑制,但发生率均〈5％。结论使用芬太尼透皮贴剂治疗中重度癌痛安全有效,可作为癌痛治疗的首选药物可作为癌痛治疗的首选药物。     

Quality of life associated with daily opioid therapy in a primary care chronic pain sample.

BACKGROUND: Daily opioid therapy is widely used in the treatment of chronic noncancer pain, yet there is limited empirical evidence on the relationship of opioid dosing and health-related quality of life (HRQoL) in primary care settings. METHODS: An analysis was conducted to assess the relationship of opioid dose to quality of life. The sample consisted of 801 chronic pain patients who were prescribed daily opioids and 93 nonopioid users recruited from the practices of 235 primary care physicians. Eight HRQoL domain scores were calculated and compared with US norms and across opioid use groups. A new modeling technique, propensity score matching analysis, was performed to adjust for potential confounding factors across 4 morphine-equivalent opioid dose groups (<20 mg, 20-40 mg, 41-105 mg, >105 mg). RESULTS: HRQoL scores were significantly lower in chronic noncancer pain patients relative to the US general population regardless of opioid use. In unadjusted comparisons, those using up to 20 mg/d of opioids had the highest HRQoL scores, whereas those using >105 mg/d had the lowest. After adjusting for potential confounders, those in the 20 mg to 40 mg/d dosing group had significantly better HRQoL scores than their nonopioid-treated or higher dosed counterparts. CONCLUSION: Use of low- to moderate-dose opioid therapy provides an improvement in HRQoL scores for chronic noncancer pain patients compared to no opioid therapy, while high-dose opioids have a smaller positive effect that is limited to mental health quality of life and patient satisfaction, and that may not justify treatment.     

Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin

The United States is currently in the midst of the worst drug epidemic in its history, with nearly 64,000 overdose deaths in 2016. In response, pharmaceutical companies have begun introducing abuse‐deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. In particular, I show that heroin is substantially more likely to be injected than OxyContin, increasing exposure to blood‐borne diseases. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation, we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011 to 2015. I find some suggestive evidence that the reformulation also lead to increases in HIV and hepatitis A, although these findings are less robust. These findings have important implications for future policies addressing the opioid crisis.     

Swallowing the pill of adverse effects: A qualitative study of patients' and pharmacists' experiences and decision‐making regarding the adverse effects of chronic pain medications

IntroductionPharmacological treatments of chronic pain can lead to numerous and sometimes serious adverse effects. Drawing on a social science approach to chronic illness, this study aimed to understand the experiences of people living with chronic pain and community pharmacists regarding the definition, prevention and management of analgesic adverse effects.MethodsThis qualitative study proceeded through 12 online focus groups (FGs) with people living with chronic pain (n = 26) and community pharmacists (n = 19), conducted between July 2020 and February 2021 in the province of Quebec, Canada. The semistructured discussion guides covered participants'' definitions of adverse effects and decision‐making regarding their prevention and management. Discussions were audio‐recorded, transcribed verbatim and analysed using grounded theory.ResultsBoth people with chronic pain and pharmacists provided varying definitions of analgesic adverse effects depending on patients'' social and clinical characteristics. Present quality of life and serious long‐term risks related to treatment were described as key dimensions influencing adverse effect appraisal. Dilemmas and discrepancies occurred between patients and pharmacists when choosing to prioritize pain relief or adverse effect prevention. Some patients lacked information about their medications and wanted to be more involved in decisions, while many pharmacists were concerned by patients'' self‐management of adverse effects. Preventing opioid‐related overdoses often led pharmacists to policing practices. Despite most pharmacists wishing they could have a key role in the management of pain and adverse effects face organizational and financial barriers.ConclusionDefining, preventing and managing adverse effects in the treatment of chronic pain requires a person‐centred approach and shared decision‐making. Clinical training improvements and healthcare organization changes are needed to support pharmacists in providing patients with community‐based follow‐up and reliable information about the adverse effects of chronic pain treatments.Patient or Public ContributionA person with lived experience of chronic pain was involved as a coinvestigator in the study. He contributed to shaping the study design and objectives, including major methodological decisions such as the choice of pharmacists as the most appropriate professionals to investigate. In addition, 26 individuals with chronic pain shared their experiences extensively during the FGs.     

Chronic neck and shoulder pain,age, and working conditions: longitudinal results from a large random sample in France

Aims: To analyse the effects of age and occupational factors on both the incidence and the disappearance of chronic neck and shoulder pain after a five year follow up period.

Methods: A prospective longitudinal investigation (ESTEV) was carried out in 1990 and 1995 in seven regions of France. A random sample of male and female workers born in 1938, 1943, 1948, and 1953 was selected from the occupational physicians' files. In 1990, 21 378 subjects were interviewed (88% of those contacted), and 87% were interviewed again in 1995. Chronic neck and shoulder pain satisfying specific criteria, and psychosocial working conditions were investigated by a structured self administered questionnaire and a clinical examination.

Results: Prevalence (men 7.8%, women 14.8% in 1990) and incidence (men 7.3%, women 12.5% for the period 1990–95) of chronic neck and shoulder pain increased with age, and were more frequent among women than men in every birth cohort. The disappearance rate of chronic neck and shoulder pain decreased with age. Some adverse working conditions (repetitive work under time constraints, awkward work for men, repetitive work for women) contributed to the development of these disorders, independently of age. Psychosocial factors seemed to play a role in both the development and disappearance of chronic neck and shoulder pain. Data did not show specific interactions between age and working conditions.

Conclusions: The aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain. A better understanding of work activity regulation of older workers can open up new preventive prospects.

     

Just one opioid prescription?

It can be said that chronic pain patients comprise a large part of general practice. It would be accepted that general practitioners treat pain to the best of their abilities and, where indicated, use opioids for this purpose. After all, opioids have been used for the treatment of cancer and acute pain for many years. While a growing body of literature documents the trend of acceptance to prescribe opioids for the treatment of chronic noncancer pain, recent evidence suggests opioids may not achieve key outcomes of chronic pain management.