Effect of expression of P-glycoprotein in tumor tissue on analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain
10.3760/cma.j.issn.0254-1416.2010.10.018
- VernacularTitle:P-糖蛋白表达对晚期癌痛病人吗啡或丁丙诺啡镇痛效果的影响
- Author:
Jun WANG
;
Yiping HU
;
Xiao LI
;
Shudong YANG
;
Lin GUO
- Publication Type:Journal Article
- Keywords:
Glycoproteins;
Morphine;
Buprenorphine;
Neoplasms;
Analgesia
- From:
Chinese Journal of Anesthesiology
2010;30(10):1212-1215
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in tumor tissue on analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain. Methods One hundred and fifty advanced cancer patients with pain aged 51-64 yr weighing 54-65 kg were included in this study. The expression of P-gp was negative in the tumor tissue in 50 patients (group M1 and B1, n = 25 each) and positive in 100 patients (group M2 ,M3 ,and B2 ,B3, n =25 each). The PCA regimen for the 6 groups were listed in the table .Pain was assessed with VAS scores (0 = no pain, 10 = worst pain) and venous blood samples were taken for determination of blood morphine/buprenorphine concentrations at 4, 12, 24 and 48 h of PCIA. Results The six groups were comparable with respect to age, body weight, M/F sex ratio, types of cancer, baseline pain level and education. The analgesic efficacy of morphine and buprenorphine was better ( VAS scores were significantly lower)in P-gp expression negative patients (group M1 and B1 ) than in P-gp expression positive patients (group M2 and B2 ). Higher doses of morphine and buprenorphine provided better analgesic efficacy in P-gp expression positive patients in group M3 and B3 than in group M2 and B2. Plasma morphine and buprenorphine concentrations were comparable between group M1 , B1 and M2, B2 and were significantly higher in group M3 and B3 at each time point. Conclusion Positive P-gp expression in the tumor tissue can decrease the analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain.
