Cherny N I
Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
CA Cancer J Clin. 2000 Mar-Apr;50(2):70-116; quiz 117-20. doi: 10.3322/canjclin.50.2.70.
Any therapeutic strategy developed for patients experiencing cancer pain depends on the goals of care, which can be broadly categorized as prolonging survival, optimizing comfort, and optimizing function. The relative priority of these goals for any individual should direct therapeutic decision-making. By combining primary treatments, systemic analgesic agents, and other techniques, most cancer patients can achieve satisfactory relief of pain. In cases where pain appears refractory to these interventions, invasive anesthetic or neurosurgical maneuvers may be necessary, and sedation may be offered to those with unrelieved pain at the end of life. The principles of analgesic therapy are presented, as well as the practical issues involved in drug administration, ranging from calculating dosage to adverse effects, and, when necessary, how to switch and/or combine therapies. Adjuvant analgesics, which are drugs indicated for purposes other than relief of pain but which may have analgesic effects, are also listed and discussed in some detail. Surgical and neurodestructive techniques, such as rhizotomy or cordotomy, although not frequently required or performed, represent yet other options for patients with unremitting pain and diminished hope of relief. Although cancer pain can be a complex medical problem arising from multiple sources, patients should be assured that suffering is not inevitable and that relief is attainable.
为癌症疼痛患者制定的任何治疗策略都取决于护理目标，这些目标大致可分为延长生存期、优化舒适度和优化功能。这些目标对任何个体的相对优先级应指导治疗决策。通过结合主要治疗方法、全身镇痛药和其他技术，大多数癌症患者的疼痛都能得到满意缓解。对于那些对这些干预措施似乎无效的疼痛病例，可能需要采取侵入性麻醉或神经外科手术，对于临终时疼痛仍未缓解的患者，可给予镇静治疗。文中介绍了镇痛治疗的原则，以及药物给药过程中涉及的实际问题，从计算剂量到不良反应，必要时还介绍了如何换药和/或联合治疗。辅助镇痛药也被列出并进行了详细讨论，这些药物并非用于缓解疼痛，但可能具有镇痛作用。手术和神经破坏技术，如神经根切断术或脊髓切断术，虽然不常需要或进行，但对于疼痛持续且缓解希望渺茫的患者来说，也是其他选择。尽管癌症疼痛可能是一个由多种原因引起的复杂医学问题，但应向患者保证，痛苦并非不可避免，缓解是可以实现的。
