Valentine Alan D
The University of Texas M.D. Anderson Cancer Center, Psychiatry Section, Department of Neuro-Oncology, 1515 Holcombe Blvd, Unit 431, Houston, TX 77030, USA.
Curr Pain Headache Rep. 2003 Aug;7(4):262-9. doi: 10.1007/s11916-003-0046-9.
Depressive disorders and pain syndromes are very common in the experience of cancer patients and may be experienced simultaneously. There is an intuitive association between cancer pain and cancer depression, both of which are multidimensional entities. Research has suggested, but not conclusively proven a cause-effect relationship. Suicidal ideation is a common concern in cancer patients with severe depression or pain. Antidepressant therapy is a mainstay of management of depression. That some antidepressants have use in the management of cancer pain may influence choice of drug selection in depressed patients. Antidepressant side effects and the patient's drug history are relevant variables. Because antidepressants that are effective as coanalgesics may not be tolerated at doses effective for depression, the clinician must be familiar with newer classes of antidepressants and psychostimulants. Combination drug therapy may be required. Psychotherapy also is common to the treatment of cancer pain and depression. With or without the intervention of pain and mental health specialists, ongoing supportive therapy from the primary clinician is essential.
抑郁症和疼痛综合征在癌症患者的经历中非常常见，并且可能同时出现。癌症疼痛和癌症抑郁之间存在一种直观的关联，二者都是多维度的情况。研究表明，但尚未确凿证明存在因果关系。自杀观念是患有严重抑郁症或疼痛的癌症患者的一个常见问题。抗抑郁治疗是抑郁症管理的主要手段。一些抗抑郁药可用于癌症疼痛的管理，这可能会影响抑郁症患者药物选择。抗抑郁药的副作用和患者的用药史是相关变量。由于作为辅助镇痛药有效的抗抑郁药在对抑郁症有效的剂量下可能无法耐受，临床医生必须熟悉新型抗抑郁药和精神兴奋剂。可能需要联合药物治疗。心理治疗在癌症疼痛和抑郁症的治疗中也很常见。无论是否有疼痛和心理健康专家的干预，初级临床医生持续的支持性治疗都是必不可少的。
