药剂科在GPMWard创建中的作用__培训课件.ppt

底色改淡。 底色改淡。 10. McNicol E, et al. J Clin Oncol 2004; 22:1975-1992.11. Marinangeli F, et al. J Pain Symptom Manage 2004; 27:409-416. systematic review10 of six trials compared the efficacy of an NSAID versus a “weak” opioid (three were single-dose trials and two were multiple-dose trials, and the duration of one trial was unclear). Again, the results failed to show the superiority of “weak” opioids over NSAIDs, although adverse events were either comparable or more frequent in the opioid-treated patients. An additional eight trials were con- ducted in 833 patients to compare an NSAID with the combina- tion of an NSAID and an opioid. The results showed that the difference in the analgesic outcome measure for each trial was less than 25%. The new algorithm proposes the following three stages of treatment for cancer pain. (1) For mild pain, non-opioid analge- sic treatment should be initiated. If pain is not adequately con- trolled, then low doses of “strong” opioids should be added and titrated according to the individual patient’s needs. (2) For mod- erate pain, low doses of “strong” opioids should be initiated and titrated, with or without non-opioids. (3) The treatment of se vere pain obviously requires the immediate use of “strong” opioids, with or without non-opioids. Invasive procedures such as neurolytic blocks, if available, should be considered as an alternative or adjunct to pharmacotherapy at any stage of dis- ease in patients with moderate or severe cancer pain. Adjuvant drugs should be used for all stages when indicated. As a rule,“weak” opioids should be dropped in the treatment of cancer, other than in countries where “strong” opioids are not readily available or physicians are not well trained in using them. In such cases, clinicians must bear in mind that the efficacy of “weak” opioids is limited. Finally, although a number of controlled trials provide data to support the efficacy and safety of this suggested algorithm, further validation should