盐酸曲马多缓释片对肌肉骨骼系统慢性疼痛患者的治疗优势(英文)

Advantage of controlled-release tramadol in treatment of chronic musculoskeletal pain

背景:肌肉骨骼系统慢性疼痛可导致患者功能残疾和生活质量下降。探讨肌肉骨骼系统疾病的治疗方法,选择恰当的治疗药物对患者具有重要意义。目的:评价盐酸曲马多缓释片毒曼丁对中度以上肌肉骨骼系统慢性持续性疼痛患者的镇痛效果及其耐受性。设计:前后对照研究。单位:北京大学人民医院关节病研究所。对象:选择2000-03/06在北京大学人民医院骨科门诊求诊的患者,具有中度以上慢性非癌症性疼痛,应用非类固醇抗炎药物(nonsteroidalan-ti-inflammatrrydrugs,NSAIDs)疼痛缓解不满意的成人病例共40例。方法:停用其他止痛药物和NSAID类药物,然后服用盐酸曲马多缓释片(奇曼丁),首剂50mg,每12h1次,根据疼痛控制程度调整剂量,每次50mg递增,最高剂量400mg/d。观察时间为4周,受试者记录疼痛治疗手册,每周门诊随访1次,医师检查后填写临床观察表。主要观察指标:患者服用药物前后的疼痛程度、疼痛缓解度和所有副作用及其严重程度。结果:全部病例均完成试验,无失访,无因不能耐受而中途退出者。服药前疼痛评分平均为(6.80±1.84)分,服药后平均为(1.00±1.46)分,差异有显著性意义(P<0.001)。平均疼痛缓解度为(85.50±5.35)%,其中完全缓解和明显缓解占78%。出现的副作用有9例,总发生率为22%,其中以眩晕最常见,共有6例,其他包括恶心3例,嗜睡2例,呕吐1例,食欲缺乏1例,便秘和排尿困难1例,视力模糊1例等。结论:盐酸曲马多缓释片是一种长效中枢性镇痛剂,使用方便。在治疗肌肉骨骼系统慢性疼痛方面具有优良的镇痛效果,不良反应轻,有良好的耐受性,为骨科慢性疼痛的药物治疗提供了一种新的选择。

BACKGROUND:Chronic musculoskeletal pain can cause disability and decreased qu ality of life of patients.Probing into the therapeutic methods of musculoskeleta l disease and choosing proper treatment drugs are important for patients. OBJECTIVE:To evaluate the efficacy and tolerance of controlled- release tram adol in patients with moderate to severe chronic pain of musculoskeletal origin. DESIGN:A self- control study was conducted. SETTING:Arthrtosis Institute,People's Hospital Affiliated to Peking Universit y. PARTICIPANTS:Patients who were in the Orthopaedic Outpatient Service , People 's Hospital of Peking University were involved.This observational study was cond ucted in 40 adults who experienced moderate to moderately severe chronic musculo skeletal pain that was not controlled by routine nonsteroidal anti- inflammator y drugs(NSAID) therapy. INTERVENTIONS:Any NSAIDs and other analgesics were prohibited. Patients initi ally took 50 mg of controlled- release tramadol (Tramcontin) every 12 hours,sup plemented by every 50 mg if insufficient pain relieved.Recommended daily maximum dose was 400 mg per day.The observation lasted for 4 weeks.The patients were as ked for document therapy- relevant data every day and were interviewed every we ek to doctor assessment. MAIN OUTCOME MEASURES:Pain intensity before and after treatment,pain remissio n degree, all side effects and their severity. RESULTS:All cases were finished the study and no one withdrew from follow- u p.No eligible patients exited from the study because of therapeutic failure or i ntolerance.In comparison with the initial visual analogue scale (VAS)mean value 6.80± 1.84,the average VAS value at the end of observation was 1.00± 1.46,whic h had significant difference(P< 0.001).An average pain reduction of (85.50± 5.3 5)% was obtained,among which 78% were absolutely and obviously lessened.Side effects were reported in 9 cases (22% ). Drowsiness and dizziness(6 cases) was the most common, followed by nausea (3 cases),vomiting (1 case), somnolence (2 cases),constipation and urinary retentio n (1 case) and blurred vision (1 case). CONCLUSION:Tramcontin, as slow- release tramadol,proved to be an effective,s afe,and easy- to- use central acting analgesic has an important role in the ma nagement of chronic musculoskeletal pain.Light side effect and good tolerance ha s provided a new choice for treatment of chronic pain in the orthopaedic departm ent.