於疼痛門診以Parecoxib治療慢性頑固性疼痛之急性發作的臨床經驗

Clinical Experiences with Parecoxib in the Treatment of Chronic Intractable Pain with Acute Manifestation in Pain Clinic

研究目的：一種新的COX-2抑制劑Parecoxib已被臨床研究證實為一強效止痛藥物，也是目前唯一可注射且起始作用快速的長效型COX-2抑制止痛劑。本研究報告15位有慢性頑固性疼痛之病人，經長期規律性治療但突發嚴重之疼痛情況時，於疼痛門診給于Parecoxib注射得到疼痛之緩解的案例分析統計。方法：在病患於疼痛門診給予Parecoxib 40毫克肌注治療前、後作效果評估，同時依據語言疼痛量表（0-10分）、情緒干擾評分（0-3分）、睡眠干擾評分（0-3分）及日常活動干擾評分（0-4分）等，於門診開始評估後，並繼續以電話追蹤至24小時。病人使用P的co：泊b治療後之滿意度（0-4分）及副作用亦予追蹤記錄。所有治療前後之數據均以配對的Student’st－臼st作統計分析，p＜白的被視為統計上有意義之差異。結果：在15位病患給予Parecoxib治療中，有2位完全沒效﹔其中13位有效的個案中，9位為男性、4位為女性，平均年齡為49.7歲（範囡：34-88）。其他於治療前、後之數據以M甜n±SD表示者包括：疼痛分數為9.5±0.8vs3.1±1.9，情緒干擾分數為2.7±0.5vs0.4±0.5，睡眠干擾分數為2.2±0.7vs0.1±0.3及日常活動干擾分數為1.4±0.7vs0.2±0.4；而藥效開始作用時間為10.3±3.7分鐘及有效止痛時間為16.3±8.0小時﹔病人的滿意度為3.7士0.5分﹔所有治療前後之數據比較均有統計上明顯的差異（p<0.001）。同時，病人在使用P缸自oxib治療過程中均沒有明顯之副作用。結論：Parecoxib可於疼痛門診中，成功的治療大部分的慢性頑固性疼痛之突發性嚴重之疼痛情況，其止痛效果起始作用快速且長效，除在肌肉骨骼之疼痛上有明顯之效果外，其他如內臟性、癌病有關及神經病變性之疼痛亦有效果。

Aim of Investigation: A newer COX-2 inhibitor Parecoxib has demonstrated powerful analgesic efficacy in well-documented clinical trials. It is the only injectable COX-2 inhibitor with fast onset and long-lasting analgesic effect. We report fifteen patients with acute attacks of severe pain under long-term regular treatment of chronic intractable pain of the head, chest, back, abdominal and extremity areas, in those treated with Parecoxib for pain relief, in our Pain Clinic. Methods: Response was assessed before and after the injection of Parecoxib 40 mg intramuscularly, with follow-up for 24 hours. We evaluated the response to management using a verbal ranking scale which included a 0-10 pain intensity scale; profile of mood state induced by pain (0-3); quality of sleep (0-3) and activity status (Eastern Cooperative Oncology Group 'ECOG' Scale: 0-4). We also recorded patient satisfaction (Scale 0-4) and adverse effects during treatment with Parecoxib. Data was analyzed by paired Students t-test with p<0.05 considered statistically significant. Results: Fifteen patients were enrolled in this study and treated with Parecoxib, but only 13 cases had effective pain relief, and 2 cases failed. Among the 13 effective cases, 9 are male and 4 are female, with average age of 49.7 years (range: 34-88). All data showed in mean± SD, before and after treatment, included pain score 9.5±0.8 vs. 3.1±1.9; mood scale 2.7±0.5 vs. 0.4±0.5; sleep scale 2.2±0.7 vs. 0.1±0.3; and daily activity status, 1.4±0.7 vs. 0.2±0.4 respectively. The onset time was 10.3± 3.7 minutes and the duration of analgesia was 16.3± 8.0 hours. The overall satisfaction was 3.7±0.5. All data compared before and after treatment was shown as statistically significant (p<0.001). Moreover, there were no specific adverse effects ocurring during the course of treatment with Parecoxib. Conclusions: Parecoxib is found to effectively treat chronic intractable pain as seen with acute manifestation in our pain clinic. Its analgesic efficacy obviously is fast onset and long duration, and it is effective not only in musculo-skeletal pain, but also in visceral, cancer-related, and neuropathic pain.