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
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摘要
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。
Objective:To explore the efficacy and safety of morphine hydrochloride sustained-release tablet combined with pregabalin in the treatment of neuropathic cancer pain.Methods:95 patients with neuropathic cancer pain were randomly divided into 3 groups:Morphine hydrochloride sustained-release tablets combined with pregabalin group,morphine hydrochloride sustained-release tablets group and pregabalin group.The three groups after treated for 60 days of the daily doses,NRS score,quality of life and adverse reactions were compared at the beginning and the ending.Results:Combined treatment group[(40.8±5.23) mg and(178.5±8.93) mg] was had the lower doses compared to morphine hydrochloride sustained-release tablets group[(63.8±6.37) mg] and pregabalin group[(284.3±8.74) mg] in the end of experiment(P<0.05).Compared to the morphine hydrochloride tablets group and the pregabalin group,the pain in the combined treatment group significantly decreased the disturbance of the daily activities of the patients(P<0.05).The adverse reactions including constipation,drowsiness,peripheral edema and vomiting were in the three groups,however there were no statistical significance in the three groups(P>0.05).Conclusion:Combined treatment with morphine hydrochloride sustained-release tablets plus pregabalin may be an effective and safe therapeutic strategy for neuropathic cancer pain.
Objective:To explore the efficacy and safety of morphine hydrochloride sustained-release tablet combined with pregabalin in the treatment of neuropathic cancer pain.Methods:95 patients with neuropathic cancer pain were randomly divided into 3 groups:Morphine hydrochloride sustained-release tablets combined with pregabalin group,morphine hydrochloride sustained-release tablets group and pregabalin group.The three groups after treated for 60 days of the daily doses,NRS score,quality of life and adverse reactions were compared at the beginning and the ending.Results:Combined treatment group[(40.8±5.23) mg and(178.5±8.93) mg] was had the lower doses compared to morphine hydrochloride sustained-release tablets group[(63.8±6.37) mg] and pregabalin group[(284.3±8.74) mg] in the end of experiment(P<0.05).Compared to the morphine hydrochloride tablets group and the pregabalin group,the pain in the combined treatment group significantly decreased the disturbance of the daily activities of the patients(P<0.05).The adverse reactions including constipation,drowsiness,peripheral edema and vomiting were in the three groups,however there were no statistical significance in the three groups(P>0.05).Conclusion:Combined treatment with morphine hydrochloride sustained-release tablets plus pregabalin may be an effective and safe therapeutic strategy for neuropathic cancer pain.
引文
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[18] Zhou B,Wang P,Sun H,et al.Clinical study of pregabalin with opioids in the treatment of malignant neuropathic pain[J].Chinese Clinical Oncology,2014,19(9):833-837.[周斌,王品,孙浩,等.普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛的临床研究[J].临床肿瘤学杂志,2014,19(9):833-837.]
[2] Darkovska-Serafimovska M,Serafimovska T.Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases[J].J Pain Res,2018,11:837-842.
[3] Qin DA,Song JF,Song LP,et al.Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer[J].J Int Med Res,2018,46(5):2023-2030.
[4] Han MM,Yang CW,Cheung CW,et al.Blockage of spinal endothelin A receptors attenuates bone cancer pain via regulation of the Akt/ERK signaling pathway in mice[J].Neuropeptides,2018,68:36-42.
[5] Ju Y,Tian D,Tan Y,et al.Palliative care with cervical intrathecal infusion and external pump for a late-stage cancer patient with refractory pain:A case report[J].Medicine(Baltimore),2018,97(4):e9714.
[6] Jutzeler CR,Warner FM,Cragg JJ,et al.Placebo response in neuropathic pain after spinal cord injury:A Meta-analysis of individual participant data[J].J Pain Res,2018,11:901-912.
[7] Raicher I,Stump Prnag,Harnik SB,et al.Neuropathic pain in leprosy:Symptom profile characterization and comparison with neuropathic pain of other etiologies[J].Pain Rep,2018,3(2):e638.
[8] Stockstill K,Doyle TM,Yan X,et al.Dysregulation of sphingolipid metabolism contributes to bortezomib-induced neuropathic pain[J].J Exp Med,2018,215(5):1301-1313.
[9] Zhou R,Xu T,Liu X,et al.Activation of spinal dorsal horn P2Y13 receptors can promote the expression of IL-1β and IL-6 in rats with diabetic neuropathic pain[J].J Pain Res,2018,11:615-628.
[10] Wang Y,Yang H,Shen C,et al.Morphine and pregabalin in the treatment of neuropathic pain[J].Exp Ther Med,2017,13(4):1393-1397.
[11] Vigneri S,Sindaco G,La Grua M,et al.Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain:A noncontrolled prospective study[J].J Pain Res,2016,9:1081-1087.
[12] Asaoka Y,Kato T,Ide S,et al.Pregabalin induces conditioned place preference in the rat during the early,but not late,stage of neuropathic pain[J].Neurosci Lett,2018,668:133-137.
[13] Emir B,Johnson K,Kuhn M,et al.Predictive modeling of response to pregabalin for the treatment of neuropathic pain using 6-week observational data:A spectrum of modern analytics applications[J].Clin Ther,2017,39(1):98-106.
[14] Parsons B,Argoff CE,Clair A,et al.Improvement in pain severity category in clinical trials of pregabalin[J].J Pain Res,2016,9:779-785.
[15] Ogawa S,Arakawa A,Hayakawa K,et al.Pregabalin for neuropathic pain:Why benefits could be expected for multiple pain conditions[J].Clin Drug Investig,2016,36(11):877-888.
[16] Wang Y,Yang H,Shen C,et al.Morphine and pregabalin in the treatment of neuropathic pain[J].Exp Ther Med,2017,13(4):1393-1397
[17] Dou Z,Jiang ZB,Zhong JC.Efficacy of combined treatment with morphine plus pregabalin[J].Journal of Clinical Anesthesiology,2013,29(6):538-541.[窦智,蒋宗滨,钟进才.普瑞巴林与吗啡联合应用对癌性神经病理性疼痛的治疗效果[J].临床麻醉学杂志,2013,29(6):538-541.]
[18] Zhou B,Wang P,Sun H,et al.Clinical study of pregabalin with opioids in the treatment of malignant neuropathic pain[J].Chinese Clinical Oncology,2014,19(9):833-837.[周斌,王品,孙浩,等.普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛的临床研究[J].临床肿瘤学杂志,2014,19(9):833-837.]