Ross Joy R, Quigley Columba
Department of Palliative Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
Eur J Pain. 2003;7(5):481-3. doi: 10.1016/S1090-3801(02)00148-9.
While morphine is historically the gold standard for the management of severe cancer pain, some patients either do not achieve adequate analgesia, or suffer intolerable side-effects. For these patients an alternative opioid is recommended. One such alternative is the potent mu opioid agonist fentanyl, delivered in a transdermal controlled release formulation. Similar to morphine, transdermal fentanyl is effective for the management of moderate to severe cancer pain. However, inappropriate prescribing of transdermal fentanyl, particularly in the clinical setting of unstable pain, can cause significant opioid toxicity, as highlighted in the case reports described.
虽然从历史上看，吗啡是治疗重度癌痛的金标准，但一些患者要么镇痛效果不佳，要么遭受难以忍受的副作用。对于这些患者，建议使用替代阿片类药物。一种这样的替代药物是强效μ阿片受体激动剂芬太尼，它以透皮控释制剂的形式给药。与吗啡类似，透皮芬太尼对中度至重度癌痛的治疗有效。然而，如所描述的病例报告中所强调的，透皮芬太尼的不恰当处方，尤其是在疼痛不稳定的临床情况下，可导致严重的阿片类药物毒性。
