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首页> 外文期刊>The American journal of hospice and palliative care >Hyperalgesia and opioid switching.
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Hyperalgesia and opioid switching.

机译：痛觉过敏和阿片类药物转换。

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摘要

Opioids, intended to abolish pain, can unexpectedly produce hyperalgesia, particularly during rapid opioid escalation. Opioid switching could be a therapeutic option in a condition of opioid-induced tolerance or hyperalgesia, but conversion ratios between opioids are difficult to apply in this context and require strict surveillance and expertise. This situation is challenging, because the rapid escalation of opioid doses, possibly due to the development of opioid-induced tolerance, can cause hyperalgesia. To avoid this adverse effect, clinicians need to refine their assessment of pain treatment and consider opioid switching. The authors present a case report in which switching from fentanyl to methadone was effective in a patient who developed hyperalgesia as a consequence of a rapid opioid escalation. Regardless of the expected clinical improvement of opioid switching using lower doses of the second opioid, the final dose of the second opioid was exaggeratedly low, probably as a consequence of the disappearance of hyperalgesia induced by the first opioid. The results of this case and others like it may help practitioners develop a meaningful approach during opioid escalation, possibly anticipating the need for opioid switching or other alternative measures for patients with uncontrolled cancer pain.
机译：旨在消除疼痛的阿片类药物会意外产生痛觉过敏，尤其是在阿片类药物快速升级期间。在阿片类药物引起的耐受性或痛觉过敏的情况下，阿片类药物转换可能是一种治疗选择，但是在这种情况下，阿片类药物之间的转化率很难应用，并且需要严格的监视和专门知识。这种情况具有挑战性，因为阿片类药物剂量的迅速增加（可能是由于阿片类药物诱导的耐受性的发展）可能引起痛觉过敏。为了避免这种不利影响，临床医生需要完善他们对疼痛治疗的评估，并考虑使用阿片类药物治疗。作者提出了一个病例报告，其中对因快速阿片类药物快速升级而导致痛觉过敏的患者，从芬太尼换成美沙酮是有效的。不管使用较低剂量的第二种阿片类药物有望在临床上改善阿片类药物的使用，第二种阿片类药物的最终剂量都过低，这可能是由于第一种阿片类药物引起的痛觉过敏消失的结果。该案例及其他类似案例的结果可能会帮助从业者在阿片类药物升级期间开发一种有意义的方法，可能预料到对于癌症疼痛不受控制的患者需要使用阿片类药物转换或其他替代措施。

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