Schug S A, Dunlop R, Zech D
Department of Pharmacology and Clinical Pharmacology, School of Medicine, University of Auckland, New Zealand.
Drugs. 1992 Jan;43(1):44-53. doi: 10.2165/00003495-199243010-00005.
Cancer pain remains a major cause of suffering. Improvements in its management have made unrelieved cancer pain unacceptable. While pharmacotherapy is the mainstay of cancer pain treatment, other options such as radiotherapy, nerve blocks, etc., have to be considered as well. A comprehensive approach must also address psychosocial issues. A successful pharmacotherapy programme for cancer pain requires careful assessment of the origin and cause of the pain. The selection of analgesics has to be rationalised using a sequential approach such as the WHO stepladder. Oral application by the block in an individually titrated dosage is recommended. Although morphine remains the most useful opioid, it should be used in combination with nonopioids. Co-analgesics, which contribute to analgesia without being classical analgesics, should be used to treat pain of specific origin. Here membrane-stabilizers, antidepressants and steroids play an often underestimated role in the treatment of neurogenic pain. Anxiolytics and major tranquillisers should be avoided because they cause sedation without improving quality of analgesia. Calcitonin, diphosphonates and spasmolytics are of minor importance in this regard. Finally, concomitant medication to treat side effects of the therapy may be necessary in formulating a comprehensive treatment plan.
癌痛仍然是痛苦的主要根源。其治疗的改善使得无法缓解的癌痛变得不可接受。虽然药物治疗是癌痛治疗的主要手段，但也必须考虑其他选择，如放射治疗、神经阻滞等。综合治疗方法还必须解决心理社会问题。一个成功的癌痛药物治疗方案需要仔细评估疼痛的来源和原因。必须使用如世界卫生组织阶梯等循序渐进的方法来合理选择镇痛药。建议采用个体化滴定剂量的口服给药方式。虽然吗啡仍然是最有用的阿片类药物，但应与非阿片类药物联合使用。辅助镇痛药虽不是传统镇痛药，但有助于镇痛，应使用其治疗特定来源的疼痛。在此，膜稳定剂、抗抑郁药和类固醇在神经源性疼痛的治疗中往往发挥着被低估的作用。应避免使用抗焦虑药和强效镇静剂，因为它们会引起镇静作用而不改善镇痛质量。降钙素、双膦酸盐和解痉药在这方面的重要性较小。最后，在制定综合治疗方案时，可能需要使用伴随药物来治疗治疗的副作用。
