Ripamonti C, Dickerson E D
Rehabilitation and Palliative Care Division, National Cancer Institute of Milan, Italy.
Drugs. 2001;61(7):955-77. doi: 10.2165/00003495-200161070-00005.
As was the case in the era before us, in the new millennium we will continue to see an abundance of patients experiencing cancer-related pain for different reasons. Although much needless pain and suffering still affects many of those with cancer, we are presented with a medical dichotomy. With the analgesic drugs available today, and the relatively simple and effective guidelines to treat cancer pain published and disseminated by the World Health Organization, why do people with cancer continue to experience pain? As we search for the answer, the horizon may hold promising new drugs, 'old drugs' with new interest and applications, and new strategies for the field of pain therapy. Possibilities include the isolation and development of analgesics or analgesic combinations that may minimise the adverse effects which are often associated with the current therapeutic class of opioid analgesics. In addition, current research points to promising results identifying the N-methyl D-aspartate non-opioid receptor as a likely component of neuropathic pain. Drugs such as gabapentin, the mechanism of action of which is not well known, have found favour within the clinical community for their analgesic properties and good tolerability. Methadone, in a phase of resurgence, has garnered the attention of the clinical community because of its unique receptor activity and pharmacoeconomic benefits. A number of clinical studies have demonstrated that methadone has a valuable role in treating cancer pain. Perhaps, an unbalanced focus on the risks of inappropriate use, rather than the benefits, should not compromise or distract from the use of methadone as an alternative to morphine. Studies are on going to assess the potential role of methadone in treating neuropathic pain. Drugs such as cannabinoids, although currently applicable for patients with anorexia, nausea and/or vomiting, may offer benefits to patients experiencing pain. Other opportunities exist with such compounds as alpha2-adrenergic agonists, nicotine, lidocaine and ketamine. New strategies such as the switching opioids and/or their route of administration may offer improved analgesia with fewer adverse effects, thus providing therapeutic alternatives for the clinical community. In addition, there is interest in the co-administration of opioids that act on different receptors. For instance, oxycodone appears to be a kappa opioid receptor agonist and may offer enhanced analgesia when combined with morphine.
和我们之前的时代一样，在新千年里，我们仍会看到大量患者因各种原因遭受与癌症相关的疼痛。尽管许多不必要的疼痛和痛苦仍在影响着众多癌症患者，但我们面临着一种医学上的二分法。如今有了镇痛药物，世界卫生组织也发布并传播了相对简单有效的癌症疼痛治疗指南，可为什么癌症患者仍在遭受疼痛呢？在我们探寻答案的过程中，未来可能会出现有前景的新药、引发新关注和有新应用的“旧药”，以及疼痛治疗领域的新策略。可能性包括分离和研发镇痛药或镇痛组合，以尽量减少通常与当前阿片类镇痛药治疗类别相关的不良反应。此外，当前的研究表明，确定N-甲基-D-天冬氨酸非阿片受体可能是神经性疼痛的一个组成部分，这一研究成果很有前景。加巴喷丁等药物，其作用机制尚不清楚，但因其镇痛特性和良好的耐受性而受到临床界的青睐。美沙酮正处于复兴阶段，因其独特的受体活性和药物经济学优势而引起了临床界的关注。多项临床研究表明，美沙酮在治疗癌症疼痛方面具有重要作用。或许，对不当使用风险而非益处的过度关注不应妨碍或干扰将美沙酮用作吗啡的替代品。正在进行研究以评估美沙酮在治疗神经性疼痛方面的潜在作用。大麻素等药物，虽然目前适用于患有厌食症、恶心和/或呕吐的患者，但可能会给疼痛患者带来益处。α2-肾上腺素能激动剂、尼古丁、利多卡因和氯胺酮等化合物也存在其他机会。诸如更换阿片类药物和/或其给药途径等新策略可能会提供更好的镇痛效果，同时减少不良反应，从而为临床界提供治疗选择。此外，人们对联合使用作用于不同受体的阿片类药物也很感兴趣。例如，羟考酮似乎是一种κ阿片受体激动剂，与吗啡联合使用时可能会增强镇痛效果。
