美沙酮按需转换法治疗癌痛的临床研究

Clinical research with methadone Ad libitum method in the treatment of cancer pain

目的:探讨美沙酮按需转换法(Ad libitum,AL)治疗癌痛的有效性和安全性。方法:选取南京大学医学院附属金陵医院疼痛科2022年11月至2023年9月全身大剂量使用阿片类药物疼痛控制不佳的癌痛病人31例,采用每次20 mg(间隔≥2 h)按需口服美沙酮转换,观察并记录美沙酮转换前、转换第1~7天和第14天病人平均疼痛数字分级评分法(numerical rating scale,NRS)评分;记录转换前、转换第1天、第3天及第7天不良反应;转换第1天至第5天补救次数;评估转换前和转换第7、14天病人生活质量(quality of life,QOL);评价并计算病人满意度和转换成功率(NRS评分降低50%,且无不能耐受的不良反应)。结果:与转换前相比,转换第1~7天及第14天病人平均NRS评分均降低(P<0.05),生活质量明显改善(P<0.001)。补救次数随滴定时间的延长而降低。病人均未出现不能耐受的药物不良反应,总体满意度为4.0(1.0),美沙酮转换成功率为93.5%。结论:全身大剂量阿片类药物使用病人,采用每次20 mg口服美沙酮按需转换效果确切、不良反应少,病人生活质量获得改善且满意度高,适合中国人群,可供临床参考。

Objective:To investigate the effectiveness and safety of methadone with Ad libitum(AL)method for the treatment of cancer pain.Methods:A total of 31 patients with inadequately controlled cancer pain,despite the use of high-dose opioid analgesics,were selected from the Pain Department of Jinling Hospital affiliated to Medical School of Nanjing University,from November 2022 to September 2023.As-needed oral methadone conversion was administered at 20 mg per dose(with an interval≥2 hours).Average pain numerical rating scale(NRS)scores were observed and recorded before and on day 1 to 7 and day 14 after methadone conversion.Adverse reactions were recorded before and on day 1,3,and 7 after conversion.Rescue frequencies were recorded from day 1 to 5 after conversion.Patient quality of life(QOL)was assessed before and on day 7 and 14 after conversion.Patient satisfaction and conversion success rate(NRS reduction≥50%,with no intolerable adverse reactions)were evaluated and calculated.Results:Compared to before conversion,average pain NRS scores were significantly reduced on day 1 to 7 and day 14 after conversion(P<0.05),and QOL was significantly improved(P<0.001).Rescue frequencies decreased with the extension of titration time.No intolerable adverse drug reactions occurred,and the overall satisfaction rate was 4.0(1.0),with a methadone conversion success rate of 93.5%.Conclusion:In patients using high-dose systemic opioid analgesics,oral methadone conversion at 20 mg per dose as needed showed clear effectiveness,minimal adverse reactions,improved patient quality of life,and high satisfaction rate.This approach is suitable for the Chinese population and can be considered for clinical use.