Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine.

译文

阿片类药物旋转正日益成为改善疼痛管理的一种选择,尤其是在长期治疗中。由于镇痛不足和无法忍受的副作用,共有42例患者 (男性23例,女性19例; 平均年龄64.1岁) 患有严重的肌肉骨骼 (64% 例),癌症 (21%) 或神经性 (19%) 疼痛从大剂量吗啡 (120至> 240 mg/天) 转化为透皮丁丙诺啡。转化所需的丁丙诺啡剂量 (至少52.5微克/小时) 由治疗医师单独滴定。没有给出转换建议,治疗医生使用他或她自己的判断进行剂量调整。评估了疼痛缓解,总体满意度和睡眠质量 (非常好,良好,满意,差或非常差),以及至少10周和长达1年的药物不良反应的发生率和严重程度。旋转后,疼痛缓解良好/非常好的患者从5% 增加到76% (P <0.001)。只有5% 报告救济不足。77.4% 年仅使用丁丙诺啡可缓解,而17% 需要额外的阿片类药物来缓解突破性疼痛。睡眠质量 (良好/非常好) 从14% 增加到74% (P <0.005)。11.9% 年报告了不良反应,主要是由于局部刺激,并未导致治疗终止。从吗啡旋转为丁丙诺啡后,没有发现耐受性或难治性。在接受大剂量吗啡治疗的患者中,具有固定转换率的转换表的价值有限。

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