Comparison Of The Efficacy And Safety Of Oxycodone Sustained Release Tablets With Different Initial Dosages In The Control Of Moderate And Severe Cancer Pain

【Background and Objective】Cancer pain seriously affects the quality of life of cancer patients.Although the WHO three-step analgesia can effectively control the pain of patients,there are still 10% of patients WHO can not control the pain well.It is of great significance to weaken the two-step drug administration,unify the management of moderate and severe cancer pain,give specific drug dose according to specific pain score,strengthen the treatment of severe cancer pain,and provide more precise and individualized treatment for patients with moderate and severe cancer pain.Opioids are the cornerstone of the management of moderate and severe cancer pain.Oxycodone sustained-release tablets,with ready-to-release components and controlled-release components,can play a role in rapid titration and long-term maintenance,and is widely used in clinical practice.However,there is still a lack of systematic research on how to adjust the initial dosage of drugs to quickly control pain in patients with varying degrees of cancer pain.The purpose of this study was to compare the efficacy of different initial doses of oxycodone sustained-release tablets in the control of moderate and severe cancer pain,and to observe whether increasing the dose of oxycodone sustained-release tablets in an appropriate amount can achieve better cancer pain control,and to evaluate its safety.【Methods】Multi-center collection ever did not accept the opioid therapy of patients with moderately severe pain,NRS score for patients with 4-10 points(collected a total of 244 cases).Patients with NRS score of 4-5 were divided into NRS4-5 groups(106 cases).Patients with NRS score of 6 points were randomly divided into NRS6 group 1(37 cases)and NRS6 group 2(45 cases),Patients with NRS score of 7-10 points were randomly divided into NRS7-10 group 1(29 cases)and NRS7-10 group 2(27 cases).NRS4-5 group initial dose was oxycodone 10 mg,NRS6 group 1 initial dose was oxycodone 10 mg,NRS6 group 2 initial dose was oxycodone 20 mg,NRS7-10 group 1 initial dose was oxycodone 20 mg,NRS7-10 group 2 initial dose was oxycodone 30 mg,in 1 hour,12 hour,24 hour with dose adjustment according to the condition of pain control pain after taking the drug control,the outbreak of pain and treatment dose,according to the actual circumstance of patients of dose adjustment again,The 1-hour,12-hour and 24-hour pain relief rates was calculated,response rate =(total response + partial response)/total response,CR: complete response(no pain),PR: partial response(NRS≤3),and the efficacy was statistically analyzed.The constipation,nausea,vomiting,dizziness,headache,drowsiness and dyspnea of the patients in each group was observed and counted,and the outcomes was recorded.The efficacy and safety was compared.【Results】The 1-hour,12-hour and 24-hour pain relief rates of patients in the NRS4-5 group was 97.2%,95.3% and 93.4%.The 1-hour,12-hour and 24-hour pain relief rates of patients in the NRS6 group 1 was 73%,78.3% and 75.7%,respectively.The 1-hour,12-hour and 24-hour pain relief rates of patients in the NRS6 group 2 was 91.1%,95.6% and 93.3%.The 1-hour,12-hour and 24-hour pain relief rates of the NRS7-10 group 1 was 62.1%,70% and 72.4%.The 1-hour,12-hour and 24-hour pain relief rates of the NRS7-10 group 2 was 88.9%,85.2% and 88.9%.The 1-hour,12-hour and 24-hour NRS scores of NRS4-5 group after medication were better than those before medication,and the differences were statistically significant(p<0.05).The 1-hour,12-hour and 24-hour pain relief rates of NRS6 group 2 was better than the corresponding time of NRS6 group 1,and the difference was statistically significant(p<0.05).The 1-hour and 24-hour pain relief rates of NRS7-10 group 2 was better than the 1-hour and 24-hour pain relief rates of NRS7-10 group1,and the difference was statistically significant(p<0.05).The 12-hour relief rates of NRS7-10 group 2 was better than the 12-hour relief rates of NRS7-10 group1,and the difference was not statistically significant(p>0.05),which may be caused by the difference in insufficient sample size.Constipation,nausea,vomiting,dizziness,headache,drowsiness,dysuria in each group was relieved after treatment,In addition,there was no statistically significant difference between NRS 6 group 1 and NRS 6 group 2,between NRS7-10 group 1 and NRS7-10 group 2 in all adverse reaction and sleep quality(p>0.05).【Conclusion】NRS score of 4 to 5 points of pain patients given initial dose oxycodone 10 mg to control pain,NRS scores 6 points for the pain of patients to choose initial dose oxycodone 20 mg compared to initial dose oxycodone 10 mg can obtain better pain control,safety and quality of sleep is good,to provide individualized treatment for patients with pain,to provide evidence for doctors weakening two steps.Cancer pain patients with an NRS score of 7-10 choose the initial dose of oxycodone 30 mg compared with the initial dose of oxycodone 20 mg for better pain control,safety and quality of sleep is good.Patients with severe cancer pain need to increase the initial dose for intensive treatment.