嗎啡長期使用於Behcet氏症合併劇烈腹痛之病例報告

Long-term Opioid Treatment in Behcet's Syndrome with Intractable Abdominal Pain-- A Case Report

類鴉片藥物是用於治療急性或慢性癌症疼痛最有效及最強的止痛藥，然而它用於治療非癌症慢性疼痛病人仍然備受爭議。我們報告一位二十三歲Behcet氏症之男性因持續性難以忍受之腹痛，而口服非類固醇消炎止痛藥物及輕度類鴉片藥物(codeine and tramadol)都無法緩解他的疼痛，我們使用經靜脈病患自控式止痛裝置給予嗎啡能夠有效的減輕他的疼痛而且極少副作用產生，在整個213天的使用期間，最高劑量給到每天259.2毫克，並沒有身體或精神上的依賴性產生，病人的整體滿意度平均相當的高。最後我們針對長期且高劑量的使用類鴉片藥物治療之效用加以討論。

Opioids are the most potent and effective analgesics available for treating acute and chronic cancer pain, but its usefulness in treating non-cancer chronic pain is still controversial. We report a 23-year-old male suffering from Behcet's disease with persistent excruciating abdominal pain. Oral non-steroid anti-inflammation analgesics and milder opioids (codeine and tramadol) failed to relieve the pain. His excruciating abdominal pain resulting from ulcerative viscera aggravated with repeated gastrointestinal tract surgeries. Intravenous morphine given through patient-controlled analgesia (PCA) could effectively reduce his pain with minimal side effects. No sign of physical or psychological dependence was observed during the period of opiate administration, and no withdrawal phenomenon was found as the dosage was tapered. During the total treatment course of 213 days, the daily dose of morphine once surged up to 259.2 mg. The long-term opioid treatment and its possible effects are, herein, discussed.