Comparative Analysis Of The Efficacy Of Low-dose Strong Opioids And Second-step Drugs In Moderate Cancer Pain

ObjectiveThe treatment of patients with moderate cancer pain puts forward the idea of weakening the two steps.However,in clinical work,the use of two-step drugs for the treatment of patients with moderate pain still accounts for a certain proportion.And in 2018,the European Society of Oncology issued guidelines for the management of cancer pain in adults and China undefineds Standard for the diagnosis and treatment of Cancer pain(2018 Edition)all proposed that weak opioids should be used in patients with moderate pain.Small doses of strong opioids can also be used.And whether to continue to use two-step drug analgesia,there is still a large number of studies to confirm.The effects of low-dose strong opioids on the NRS scores of patients with moderate pain and the changes of quality of life before and after analgesic treatment were analyzed retrospectively in comparison with two-step drugs in patients with moderate pain.MethodsA total of 326 patients with malignant tumors admitted to the Department of Breast Medicine of the Liaoning Provincial Cancer Hospital from June 2012 to December 2017 with moderate pain(4 ≤ NRS ≤ 6 points)were collected,and the patients included were based on analgesics.The use was divided into two groups.The low-dose strong opioid observation group consisted of 249 patients in the and the two-step drug control group consisted of 249 patients.All the data were analyzed by IBM SPSS Statistics 25 software.The chi-square test was used to compare the differences in baseline characteristics such as age,gender,metastatic site,cancer type and pain type.Measurement of variance analysis was used to evaluate changes in NRS scores and NRS scores on the 1st,2nd,3rd,5th,7th,and 14 th day after treatment in the low-dose strong opioid observation group and the two-step drug control group.Analysis of the differences between the drugs in different drug groups,using the chi-square test to compare the difference between the observation group and the control group,and analyze the differences between different drugs under Bonferroni correction test.Comparison analysis of the differernce before and after treatment patients,cancer pain everyday life,emotions,relationships,sleep,daily work and life interest changes.Results1.There was no significant difference in the baseline characteristics of gender,age,cancer type,pain type and metastatic site between the low-dose and high-dose opioid observation group and the two-step drug control group.2.The NRS scores of the low-dose strong opioid drug observation group and the two-step drug control group were significantly lower than those of the pre-treatment baseline NRS score,and were statistically significant.Compared with the two-step drug control group,the NRS scores of the low-dose strong opioid observation group were significantly lower at each time point observed,and the difference was statistically significant.3.Compared with morphine,oxycodone in patients with NRS scores decreased more significantly in the treatment of the 5 days.After the treatment of the 1st,2nd,3rd,7th,and 14 th day,there was no significant difference in the reduction of NRS scores between patients with oxycodone and morphine.In the two-step drug control group compared with codeine,the NRS score of patients with oxycodone was reduced more significantly in the treatment of the 5 days.After the treatment of the 1st,2nd,3rd,7th,and 14 th day there was no statistically significant difference in the NRS scores of patients with oxycodone,codeine,and tramadol.4.In the analysis of drug adjustment for patients with poor analgesic effect,it was found that the drug adjustment rate of the low-dose strong opioid observation group was significantly lower than that of the two-step drug control group.The adjustment rate of codeine drugs was significantly higher than that of other drugs.5.After the treatment both the two groups could significantly improve the patients daily life,mood,interpersonal relationship,sleep,daily work and life interest,but there was no statistical difference in the degree of improvement between the two groups.Conclusion:1.The NRS score of patients with low-dose strong opioids was significantly reduced and the rate of drug adjustment was low,which provided some basis for weakening the concept of two-step drugs.2.The low-dose strong opioids and two-step drug therapy can improve the quality of life of patients.3.The effect of oxycodone and morphine drugs is similar.The analgesic effects of codeine,tramadol and aminophenoloxycodone were similar,but the adjustment rate of codeine was higher.