Analysis Of Influencing Factors And Efficacy Of Opioids Titration In Outpatients With Adult Cancer Pain

Objective:To analyze the influencing factors and curative effects of titration of opioids in outpatients with cancer pain.Methods:According to the inclusion and exclusion criteria,110 outpatients with moderate to severe adult cancer pain were selected from January 2016 to April 2019 who were admitted to the Shanxi Bethune Hospital(Shanxi Academy of Medical Sciences)pain department and adopted the simplified dose titration regimen of oxycodone sustained-release tablets according to NCCN guidelines.Statistical analysis of changes in VAS scores before and after titration treatment,and evaluation of efficacy according to WHO pain treatment remission grade;statistical analysis of different sexes,pain types,and tumor metastasis on outpatient opioid titration effects,number of titration cycles,number of outbreak pains,and incidence of adverse reactions Impact.Results:The overall response rate was 90.0% after three standard titration periods,of which,there was no case of complete remission,10 cases of obvious remission(9.1%),64 cases of moderate remission(58.2%),25 cases of mild remission(22.7%)and 11 cases of no remission(10.0%).The VAS score was(4.0±1.2)after three titration periods,which was significantly lower than that at first admission(6.3±1.3)(p<0.05).The analysis on factors that influenced the occurrence times of breakthrough pain in titration revealed that the pain type and transfer condition both influenced the additional times of administration.The occurrence times of breakthrough pain were more in patients with mixed pain than those in patients with visceralgia and patients with somatic pain(p<0.05).The occurrence times of breakthrough pain were more in patients with a metastasis than those in patients without a metastasis(p<0.05).The occurrence times of breakthrough pain were not influenced by gender.The analysis on factors that influenced the periods needed to achieve a steady state showed that the number of patients with a metastasis needed for more than 3 titration periods was greater than that of patients without a metastasis and the difference was statistically significant(p<0.05).The gender and pain type had no influence on the periods needed for titration.Adverse reactions occurred during the treatment period included vomiting(incidence rate 46.4%,51/110),constipation(incidence rate 40.9%,45/110),dizziness(incidence rate 5.5%,6/110)and uroschesis(incidence rate 1.8%,2/110).No other severe adverse reactions like respiratory depression appeared.Conclusion:Opioid titration of adult patients with cancer pain in outpatient clinics can provide patients with personalized medication programs.The titration effect is obvious and no serious adverse reactions have occurred.The type of pain and tumor metastasis can have a significant impact on the opioid titration process in patients with moderate to severe cancer pain,and more attention should be paid to clinical work.