Mercadante S, Portenoy R K
Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
J Pain Symptom Manage. 2001 Feb;21(2):144-50. doi: 10.1016/s0885-3924(00)00228-1.
Pain that is poorly responsive to opioid analgesics is challenging for physicians who deal with cancer patients. Numerous factors may influence analgesic response during the course of the illness. These include changing nociception associated with disease progression, the appearance of intractable side effects, the development of tolerance, the presence of neuropathic pain, the temporal pattern, the effects produced by the production of opioid metabolites, and many others. These factors influence the delicate balance between pain relief and opioid toxicity that must be achieved in cancer patients with pain.
对阿片类镇痛药反应不佳的疼痛，给治疗癌症患者的医生带来了挑战。在疾病过程中，众多因素可能会影响镇痛效果。这些因素包括与疾病进展相关的伤害感受变化、顽固性副作用的出现、耐受性的形成、神经性疼痛的存在、时间模式、阿片类代谢产物产生的影响等等。这些因素影响着癌症疼痛患者必须实现的疼痛缓解与阿片类药物毒性之间的微妙平衡。
