Opioid treatment of painful chronic pancreatitis.

T Niemann, L G Madsen, S Larsen, N Thorsgaard
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引用次数: 43

Abstract

Background: Abdominal pain is the dominant symptom in 50-75% of patients with chronic pancreatitis, often requiring opioid analgesics. Fentanyl, a potent synthetic opioid, can be administered percutaneously at a constant dose and is claimed to have fewer systemic side effects.

Aim: To evaluate transdermal fentanyl plaster versus sustained release morphine tablets as analgesic treatment of painful chronic pancreatitis.

Methods: In an open randomized crossover trial, 18 patients were included. The treatment period was 4 wk for each drug. All patients had immediate-release morphine tablets as rescue medication.

Results: The dosage of transdermal fentanyl had to be increased on average 50% over that indicated by the manufacturer. When this was done and rescue medication was secured, no difference between the two drugs in primary endpoint or patient preference was observed. There was also no difference in the secondary endpoints, pain control, and quality of life. However, skin side effects, mostly mild, occurred in 44% of the patients during treatment with transdermal fentanyl, and the mean daily dose of immediate release morphine was significantly higher during the transdermal fentanyl period than during the sustained-release morphine period (30.7 mg vs. 14.7 mg [p < 0.01]).

Conclusion: When given in an appropriate dose, transdermal fentanyl might be useful for treatment of some patients with painful chronic pancreatitis, e.g., when tablet ingestion is difficult. However, the dosage often has to be increased above that recommended by the manufacturer. The need of rescue morphine is considerable and skin side effects often occur. Transdermal fentanyl is, therefore, not the ideal first-choice analgesic in patients with painful chronic pancreatitis.

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阿片类药物治疗疼痛性慢性胰腺炎。
背景:腹痛是50-75%慢性胰腺炎患者的主要症状,通常需要阿片类镇痛药。芬太尼是一种强效的合成阿片类药物,可以以恒定剂量经皮给药,据称对全身的副作用更少。目的:比较芬太尼透皮膏药与吗啡缓释片对疼痛性慢性胰腺炎的镇痛效果。方法:采用开放随机交叉试验,纳入18例患者。每种药物的治疗周期为4周。所有患者均给予吗啡速释片作为抢救用药。结果:经皮芬太尼的用量要比厂家规定的剂量平均增加50%。当这样做并获得抢救药物时,两种药物在主要终点或患者偏好方面没有差异。在次要终点、疼痛控制和生活质量方面也没有差异。然而,44%的患者在芬太尼透皮治疗期间出现皮肤副作用,以轻微为主,且芬太尼透皮治疗期间吗啡即刻释放的平均日剂量明显高于吗啡缓释治疗期间(30.7 mg vs. 14.7 mg [p < 0.01])。结论:经皮芬太尼在给予适当剂量的情况下,可能有助于治疗一些疼痛性慢性胰腺炎患者,例如当片剂摄入困难时。然而,剂量通常必须增加到超过制造商推荐的剂量。救援吗啡的需求是相当大的,并且经常发生皮肤副作用。因此,经皮芬太尼并不是疼痛性慢性胰腺炎患者理想的首选镇痛药。
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Photodynamic therapy for pancreatic and biliary tract carcinoma Colonic carcinoma resembling submucosal tumor Notes on 5th Annual Lustgarten Foundation for Pancreatic Cancer Research Conference, Boston, 2003 Letter from the editor Introduction to special issue of IJGC on imaging in pancreatic disease
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