在服用高剂量长期阿片类药物的患者中使用布普伦诺芬,疼痛和阿片类药物:一项随机临床试验
William C Becker1,2, Karen H Seal3,4,5, David B Nelson6,7
1VA Connecticut Healthcare System, West Haven, Connecticut.
JAMA internal medicine
|February 17, 2025
概括
切换到布普伦诺芬并没有显著改善长期阿片类药物治疗患者的疼痛评分. 两组都实现了类似的疼痛缓解和阿片类药物剂量降低,布普伦诺芬采用率较低.
科学领域:
- 疼痛管理和成医学 疼痛管理和成医学
- 临床试验和医疗服务研究 研究 临床试验和医疗服务研究
背景情况:
- 长期治疗慢性疼痛的阿片类药物有风险,指南建议在益处超过危害时减少剂量或停止使用.
- 在接受高剂量,全agonist长期阿片类药物治疗的患者中,促进阿片类药物剂量减少或中止的有效策略是有限的.
研究的目的:
- 评估选择性切换到布普伦诺啡因的疗效,作为一种改善疼痛和减少长期高剂量阿片类药物治疗患者阿片类药物使用的策略.
- 评估在协作疼痛治疗干预框架内提供布普伦诺啡因切换选项的影响.
主要方法:
- 一个实用的,多站点的,为期12个月的随机临床试验,涉及中度至重度慢性疼痛患者,接受高剂量阿片类药物治疗 (≥70 mg/d).
- 参与者被随机分配,要么接受转换为布普伦诺芬的选择,要么不接受这种选择,作为协作疼痛治疗的一部分.
- 主要结局是12个月的简要疼痛库存 (BPI) 总得分;主要的次要结局是吗啡毫克相当量的阿片类药物剂量 (MME).
主要成果:
- 在207名参与者中,26.0%的布普伦诺芬选择组进行了切换. 这两组在12个月内BPI分数略有改善,MME数量大幅减少.
- 在布普伦诺啡选择组和没有选择组之间没有观察到BPI得分的显著差异 (组间调整后平均差异[AMD], -0.09).
- 片剂量在两只手臂都大幅下降 (布普伦诺芬选择手臂的AMD,-61.0 mg/d;无选择手臂的AMD,-58.5 mg/d),没有显著的组间差异 (AMD,-2.5 mg/d).
结论:
- 与不提供这种选择相比,提供转换为布普伦诺芬的选择并没有导致疼痛结果的统计学上显著差异.
- 两组都经历了显著的疼痛改善和显著的阿片类药物剂量减少,这表明协作护理模式本身是有益的.
- 转换为布普伦诺芬的低率突出显示了潜在的障碍或患者偏好,需要进一步研究阿片类药物管理策略.
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