加巴喷丁对癌性神经病理性疼痛病人阿片耐受指数的影响
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摘要
目的:研究加巴喷丁对癌性神经病理性疼痛(malignant neuropathic pain, NP)病人阿片耐受指数的影响。方法:选择2014年6月至2016年6月兰大二院宁养院所收治神经病理性疼痛的晚期癌痛病人361例,病例筛选用《IDpian》量表。所选病例基本理想镇痛,即疼痛数字评分法<3分(numericalrating scale, NRS),且治疗周期> 90天。其中阿片联合加巴喷丁者259例,单用阿片者102例。加巴喷丁用法:逐日加量至明显起效后维持剂量,最大剂量3 600 mg/day(2～3次/天)。吗啡用法按《NCCN癌痛治疗指南》,依次进行癌痛评估、剂量滴定、维持剂量、调整剂量。观察两组的阿片耐受指数、背景痛、爆发痛、吗啡用药分布及加巴喷丁用药分布。然后进行统计学分析。结果:阿片联合加巴喷丁组平均阿片耐受指数均数明显较单用阿片组低,前者3.67±0.86,后者4.23±0.78,差异有统计学意义(P <0.01)。联合组大剂量阿片例数明显较单用组少,差异有统计学意义(P <0.01)。背景痛差异无统计学意义。24 h爆发痛联合组较低,差异有统计学意义(P <0.05)。结论:联合加巴喷丁能明显降低神经病理性癌痛者阿片耐受指数,预示加巴喷丁对癌性神经病理性疼痛具有明确的辅助镇痛作用,并能明显减少阿片用量,降低费用。但联合用药相对于单用阿片并不能明确降低背景痛程度。联合加巴喷丁能明显降低病人爆发痛次数。
Objective: To study the in?uence of gabapentin on opioid tolerance index in patients with malignant neuropathic pain(NP). Methods: A total of 361 advanced cancer patients with malignant neuropathic pain from June 2014 to June 2016 admitted to The Hospice hospital were collected for further studies. Cases screening used IDpian. The selected cases achieved a general reduction in pain, NRS(numerical rating scale) < 3 points,and the treatment period was more than 90 days, 259 cases accepted opioid joint gabapentin treatment, of which,102 cases were treated with the opioid alone. Gabapentin treatment: Daily dose increased until the effect was apparent, then maintained the effective dose. The maximum dose was 3 600 mg/d(2-3 times per day). The method of morphine treatment used the "NCCN cancer treatment guide" and in turn to assess the cancer pain, dosage titration, maintenance dose and the dosage of pain adjustment. The tolerance index, background pain, bursts of pain, distribution of morphine and distribution of gabapentin were observed and were statistically analyzed.Results: Compared with opioid alone, the combination of opioid and gabapentin lowered the average tolerance index. The former was 4.23±0.78, the latter was 3.67±0.86, the difference was statistically signi?cant(P < 0.01).The number of high dose cases in the combined group was less than that in the single group, the difference was statistically signi?cant(P < 0.01). The background pain was not statistically signi?cant. The combined group had fewer bursts of pain than the single group in 24 hours, the difference was statistically signi?cant(P < 0.05).Conclusion: The combination of gabapentin and opioid alleviated opioid tolerance index in patients with malignant neuropathic pain.
Objective: To study the in?uence of gabapentin on opioid tolerance index in patients with malignant neuropathic pain(NP). Methods: A total of 361 advanced cancer patients with malignant neuropathic pain from June 2014 to June 2016 admitted to The Hospice hospital were collected for further studies. Cases screening used IDpian. The selected cases achieved a general reduction in pain, NRS(numerical rating scale) < 3 points,and the treatment period was more than 90 days, 259 cases accepted opioid joint gabapentin treatment, of which,102 cases were treated with the opioid alone. Gabapentin treatment: Daily dose increased until the effect was apparent, then maintained the effective dose. The maximum dose was 3 600 mg/d(2-3 times per day). The method of morphine treatment used the "NCCN cancer treatment guide" and in turn to assess the cancer pain, dosage titration, maintenance dose and the dosage of pain adjustment. The tolerance index, background pain, bursts of pain, distribution of morphine and distribution of gabapentin were observed and were statistically analyzed.Results: Compared with opioid alone, the combination of opioid and gabapentin lowered the average tolerance index. The former was 4.23±0.78, the latter was 3.67±0.86, the difference was statistically signi?cant(P < 0.01).The number of high dose cases in the combined group was less than that in the single group, the difference was statistically signi?cant(P < 0.01). The background pain was not statistically signi?cant. The combined group had fewer bursts of pain than the single group in 24 hours, the difference was statistically signi?cant(P < 0.05).Conclusion: The combination of gabapentin and opioid alleviated opioid tolerance index in patients with malignant neuropathic pain.
引文
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[9]中华人民共和国卫生部(卫办医政发[2011]161号).癌症疼痛治疗规范(2011版)[J].临床肿瘤学杂志,2012,17(2):153-158.
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[11]徐建国.疼痛药物治疗学[M].2007年11月第1版,人民卫生出版社.
[12]廖子君,姚俊涛.成人癌痛《NCCN》指南,2015.
[13]Treede RD,Jensen TS,Campbell JN,et al.Neuropathic pain-Redefinition and a grading system for clinical and research purposes[J].Neurology,2008,70(18):1630-1635.
[14]Johannessen Landmark C.Relations between mechanisms of action and clinical efficacy of antiepileptic drugs is non-epilepsy conditions[J].CNS Drugs,2008,22:27-47.
[15]Baillie JK,Power I.The mechanism of action of gabapentin in neuropathic pain[J].Curr Opin Investing Drugs,2010,7(1):33-39.
[16]司马蕾,樊碧发.神经病理性癌痛的临床特点与现状控制的调查研究[J].中国疼痛医学杂志,2014,20(7):476-480.
[17]Lema MJ,Foley KM,Hausheer FH.Types and epidemiology of cancer-related neuropathic pain:the intersection of cancer pain and neuro-pathic pain[J].Oncologist,2010,15(2):3-8.
[18]Chandra K,Shafiq N,Pandhi,et al.Gabapentin versus nortriptyline in post-herpetic neuralgia patients:a randomized,double-blind clinical trial-the GONIP Trial[J].Int J Clin Pharmacol Ther,2006,44:358-363.
[19]Dworkin RH,O'Connor AB,Backonja M,et al.Pharmacologic management of neuropathic pain:evidence-based recommendations[J].Pain,2007,132:237-251.
[20]陈立平,申文.硫酸吗啡缓释片联合加巴喷丁胶囊治疗癌性疼痛的临床观察[J].中国疼痛医学杂志,2015,21(9):679-683.
[2]卢帆,宋莉,刘慧.癌性神经病理性疼痛的评估和诊疗现状[J].中国疼痛医学杂志,2015,21(9):692-693.
[3]李金祥.姑息医学-癌性疼痛与症状处理[M].成都:四川科学技术出版社,2009:116-117.
[4]Guignard B,Bossard AE,Coste C,et al.Intraoper-ative remifentanil increases postoperative pain and morphine requirement[J].Anesthesiology,2000,93:4094-4117.
[5]张宗艳,尹梅香.硫酸吗啡缓释片超大剂量应用癌痛病人1例[J].医学信息旬刊,2013,26(18):642-642.
[6]裴保香,张瑶,杨亚青.晚期癌痛病人大剂量持续静脉泵入吗啡的试行管理[J].中国药物应用与检测,2011,8(3):193-194.
[7]付金玉.浅谈加巴喷丁在神经病理性疼痛的研究进[7].展[J].医学理论与实践,2014,26(14):1851-1853.
[8]薛钧,刘晓铭.809例晚期癌痛病人阿片耐受性及量化分析方法研究[J].中国疼痛医学杂志,2014,20(4):236-240.
[9]中华人民共和国卫生部(卫办医政发[2011]161号).癌症疼痛治疗规范(2011版)[J].临床肿瘤学杂志,2012,17(2):153-158.
[10]Russell Portenoy Harden N.一种诊断神经病理性疼痛的筛选量表:ID Pain量表[J].中国新药杂志,2010,(22):2021-2021.
[11]徐建国.疼痛药物治疗学[M].2007年11月第1版,人民卫生出版社.
[12]廖子君,姚俊涛.成人癌痛《NCCN》指南,2015.
[13]Treede RD,Jensen TS,Campbell JN,et al.Neuropathic pain-Redefinition and a grading system for clinical and research purposes[J].Neurology,2008,70(18):1630-1635.
[14]Johannessen Landmark C.Relations between mechanisms of action and clinical efficacy of antiepileptic drugs is non-epilepsy conditions[J].CNS Drugs,2008,22:27-47.
[15]Baillie JK,Power I.The mechanism of action of gabapentin in neuropathic pain[J].Curr Opin Investing Drugs,2010,7(1):33-39.
[16]司马蕾,樊碧发.神经病理性癌痛的临床特点与现状控制的调查研究[J].中国疼痛医学杂志,2014,20(7):476-480.
[17]Lema MJ,Foley KM,Hausheer FH.Types and epidemiology of cancer-related neuropathic pain:the intersection of cancer pain and neuro-pathic pain[J].Oncologist,2010,15(2):3-8.
[18]Chandra K,Shafiq N,Pandhi,et al.Gabapentin versus nortriptyline in post-herpetic neuralgia patients:a randomized,double-blind clinical trial-the GONIP Trial[J].Int J Clin Pharmacol Ther,2006,44:358-363.
[19]Dworkin RH,O'Connor AB,Backonja M,et al.Pharmacologic management of neuropathic pain:evidence-based recommendations[J].Pain,2007,132:237-251.
[20]陈立平,申文.硫酸吗啡缓释片联合加巴喷丁胶囊治疗癌性疼痛的临床观察[J].中国疼痛医学杂志,2015,21(9):679-683.