本帖最後由 lsc0019 於 2009-5-28 22:37 編輯
作者：Allison Gandey
出處：WebMD醫學新聞
May 12, 2009（加州聖地牙哥）－專家們提醒，便秘是鴉片類止痛藥物非常常見的不良反應，但是因為病患可能不願討論到這個問題，而經常未被診斷出來。
在美國疼痛醫學會第28屆年會中，發表者鼓勵臨床醫師詢問使用鴉片類藥物病患的腸胃道功能。
座談會引言人，來自佛州坦帕市Lee Moffitt癌症中心與研究機構的David Craig藥學博士表示，這個數字變異很大，估計約40至80%的病患有便秘問題。
他向Medscape神經學與神經外科學強調，即使短暫使用兩天也會有這樣的作用；這些是許多病患不願討論的，因此我們必須展開對話。
發表者、來自鹽湖城猶他健康科學中心的Arthur Lipman藥學博士同意這樣的說法，他表示，我們必須與病患談論這些議題，我們真的無法低估便秘如何折磨病患的生活品質。
【許多病患不願討論這個問題】
Lipman博士指出，病患會有虛弱與不適的感覺，某些病患整天待在家裡，因為他們擔心如果他們出門的話，他們可能必須上廁所。
Lipman博士表示，應該鼓勵病患攝取纖維及水分，並且規律地運動，以降低便秘風險；對於那些已經有症狀的病患，他建議使用非處方緩瀉劑。
他表示，刺激性緩瀉藥物，例如番瀉葉與bisacodyl是好的選擇，但是他們只有一半的時間有效；許多病患將需要額外的介入。
Lipman認為，我們並未與病患有太多關於便秘的對話，原因之一是，如果他們對於緩瀉藥物沒有反應，直到最近，我們真的沒有太多辦法來處理這個問題，除了灌腸或是手動刺激排便之外。
但他指出，當傳統緩瀉劑失敗時，周邊mu鴉片受體拮抗劑提供了另一個選擇；Lipman博士提出了三個選擇：PEG-naloxol（NKTR-118，Nektar治療公司）、Alvimopan（Entereg，格蘭素史克藥廠）以及methylnaltrexone（Relistor，惠氏藥廠）。
他指出，這些藥物是昂貴的，但對其他藥物沒有反應的病患而言，這是值得的。Lipman博士表示，直腸介入對病患的尊嚴有負面影響，且他們會感覺像地獄一樣的不適。
【評估腸胃道功能】
來自休士頓德州大學安德森癌症中心的Robert Massey博士及其團隊已經以搖椅進行實驗，並要求病患在術後嘗試這項介入。Massey博士的假設是，使用搖椅的病患將會有比較少的腹部症狀。
病患一天使用一個小時的搖椅。針對45位接受腹部手術患者所進行的研究，初步結果顯示是有潛力的。溫和的搖動顯然有所幫助。初步研究結果顯示，病患的止痛藥需求量下降，腹部症狀也比較少，且比較早出院。
發表者在發表會中表示，便秘的流行病學、臨床與經濟負擔被認為是顯著的，但是我們瞭解的有限。
Craig表示，評估病患的腸胃功能將會是標準照護，我們必須認知這個大問題並與病患討論這個問題。
Craig博士報告與PriCara，Ortho-McNeil-Janssen藥廠的分公司與惠氏藥廠有資金上的關係。Lipman博士報告與惠氏藥廠有資金上的關係，以及擔任Nuvo與輝瑞藥廠的顧問，且擔任默克藥廠發言人，並領取Progenics公司的演講費。
APS 2009: Opioid-Induced Constipation Highly Prevalent
By Allison Gandey
Medscape Medical News
May 12, 2009 (San Diego, California) — Constipation is a well-known adverse effect of opioid analgesics but often goes undiagnosed because patients can be reluctant to talk about it, experts warn.
Speaking here at the American Pain Society 28th Annual Scientific Meeting, presenters encouraged clinicians to ask patients taking opioids about bowel function.
The numbers vary, but an estimated 40% to 80% of patients become constipated, said session moderator David Craig, PharmD, from the Lee Moffitt Cancer Center and Research Institute, in Tampa, Florida.
"Even a short course of opioids of just a day or 2 can have an effect," he emphasized to Medscape Neurology & Neurosurgery."It's something that many patients won't discuss, so we have to initiate the conversation."
Presenter Arthur Lipman, PharmD, from the University of Utah Health Sciences Center, in Salt Lake City, said he agrees. "We have to talk to patients about this, and we really can't underestimate how seriously constipation can erode a person's quality of life."
Many Patients Reluctant to Talk About It
Dr. Lipman says patients can experience a global feeling of malaise and discomfort. "Some patients end up sitting at home because they are afraid they may need to use the toilet if they go out."
Dr. Lipman suggests people be encouraged to increase their fiber and fluid intake and exercise regularly to minimize the risk for constipation. For those who still have symptoms, he recommends over-the-counter laxatives.
"Stimulants such as senna or bisacodyl are a good choice," he said, "but they are only effective about 50% of the time." Many patients will require additional interventions.
"I think one of the reasons we haven't done a good job talking to patients about constipation is because if they didn't respond to laxatives, until recently, we really didn't have a way to address it other than with an enema or manual disimpaction," Lipman said.
But he points out that peripheral μ-opioid–receptor antagonists are providing new alternatives when conventional laxatives fail. Dr. Lipman described 3 options: PEG-naloxol (NKTR-118, Nektar Therapeutics), alvimopan (Entereg, GlaxoSmithKline), and methylnaltrexone (Relistor, Wyeth).
"They are expensive," he noted, "but they can be worthwhile for patients who aren't responding to other options." Rectal interventions can have a negative effect on the dignity of the patient, Dr. Lipman said, "and they are as uncomfortable as hell."
Assess Bowel Function
Also speaking at the meeting was Robert Massey, PhD, from the University of Texas MD Anderson Cancer Center in Houston. His group has been experimenting with rocking chairs and asking patients to try the intervention after surgery.
Dr. Massey hypothesized that patients using the rocking chairs would have fewer abdominal symptoms.
Patients used the chairs for about an hour a day. Initial results from the study of 54 abdominal-surgery patients were promising. The gentle rocking motion appeared to help. The preliminary findings suggest that patients required less pain medication, had fewer abdominal symptoms, and were discharged from the hospital earlier.
The epidemiologic, clinical, and economic burden of constipation is thought to be significant, the presenters explained during the session, but remains incompletely understood.
"Assessing bowel function should be a standard part of care," Craig said. "We have to recognize this is a big problem and address it for our patients."
Dr. Craig reports that he has financial ties to PriCara, a division of Ortho-McNeil-Janssen Pharmaceuticals, and Wyeth. Dr. Lipman reports financial ties to Wyeth as well as working as a consultant for Nuvo and Pfizer, serving as a speaker for Merck, and receiving honoraria from Progenics.
American Pain Society 28th Annual Meeting: Abstract 317. Presented May 8, 2009. |
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