阿片类镇痛药的处方与使用——全科医生及皇家布里斯班医院多学科疼痛中心的镇痛处方审核
Opioid analgesic prescribing and use - an audit of analgesic prescribing by general practitioners and The Multidisciplinary Pain Centre at Royal Brisbane Hospital.
作者信息
Nissen L M, Tett S E, Cramond T, Williams B, Smith M T
机构信息
School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
出版信息
Br J Clin Pharmacol. 2001 Dec;52(6):693-8. doi: 10.1046/j.0306-5251.2001.01502.x.
AIMS
This study evaluated the use of and need for opioids in patients attending the Multidisciplinary Pain Centre at the Royal Brisbane Hospital (RBH).
METHODS
All consecutive in-patient admissions in 1998 were reviewed. A 10-point scoring system based on the World Health Organization (WHO) analgesic ladder was devised to facilitate comparison of analgesic prescribing on admission and at the time of discharge. A conversion table was used to standardize opioid analgesic doses to an oral morphine equivalent.
RESULTS
Of the 370 patients reviewed, 233 (81%) were by their general practitioners. Records of 288 (78%) were available for full review and 270 (94%) of these had noncancer pain. On admission, 239 (83%) were taking an opioid analgesic, with 135 (47%) taking strong opioids (e.g. morphine, oxycodone, methadone). There was a significant decrease in the mean total daily oral morphine equivalent prescribed on discharge 36.9 mg (95% CI: 33.4, 40.4) compared with that on admission 88.7 mg (95% CI: 77.6, 99.8) (P < 0.001). There was a significant decrease (P < 0.05) in the proportion of patients taking a primary opioid on discharge 153 (58%) compared with admission 239 (83%), although the proportion of patients taking a strong opioid on discharge 150 (52%) compared with admission 135 (47%) was not significantly different (P > 0.05). The proportion of patients taking a laxative showed a significant increase on discharge 110 (73%) compared with admission 38 (28%) (P < 0.05).
CONCLUSIONS
Our analgesic prescribing scoring system and opioid conversion table have the potential to be developed further as tools for assessing opioid analgesic prescribing. The significant decrease in total daily oral morphine equivalents signifies the value of prescribing in accordance with the WHO analgesic ladder, and the necessity of general practitioner education. The management of chronic pain is complex, and it requires interventions additional to pharmacological therapy. Evaluation by a multidisciplinary team, coupled with experience in and an understanding of analgesic prescribing and rehabilitation provides an effective basis for improving the management of patients with chronic pain.
目的
本研究评估了在皇家布里斯班医院（RBH）多学科疼痛中心就诊的患者中阿片类药物的使用情况及需求。
方法
对1998年所有连续住院患者进行回顾性研究。设计了一种基于世界卫生组织（WHO）镇痛阶梯的10分评分系统，以方便比较入院时和出院时的镇痛处方。使用转换表将阿片类镇痛剂剂量标准化为口服吗啡当量。
结果
在370例接受评估的患者中，233例（81%）由其全科医生转诊。288例（78%）患者的记录可供全面审查，其中270例（94%）患有非癌性疼痛。入院时，239例（83%）正在服用阿片类镇痛剂，其中135例（47%）服用强阿片类药物（如吗啡、羟考酮、美沙酮）。出院时规定的每日口服吗啡当量平均总量显著下降，为36.9毫克（95%可信区间：33.4，40.4），而入院时为88.7毫克（95%可信区间：77.6，99.8）（P<0.001）。出院时服用主要阿片类药物的患者比例显著下降（P<0.05），为153例（58%），而入院时为239例（83%），尽管出院时服用强阿片类药物的患者比例为150例（52%），与入院时的135例（47%）相比无显著差异（P>0.05）。服用泻药的患者比例在出院时显著增加，为110例（73%），而入院时为38例（28%）（P<0.05）。
结论
我们的镇痛处方评分系统和阿片类药物转换表有进一步发展成为评估阿片类镇痛处方工具的潜力。每日口服吗啡当量总量的显著下降表明按照WHO镇痛阶梯处方的价值以及全科医生教育的必要性。慢性疼痛的管理很复杂，除药物治疗外还需要其他干预措施。多学科团队的评估，以及在镇痛处方和康复方面的经验和理解，为改善慢性疼痛患者的管理提供了有效的基础。
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