Wilson George R, Reisfield Gary M
Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville, Florida, USA.
Am J Hosp Palliat Care. 2003 Nov-Dec;20(6):459-61. doi: 10.1177/104990910302000608.
We report a case of a patient with metastatic testicular cancer and intractable pain refractory to massive doses of oral, intravenous, and intrathecal (IT) opioids supported by analgesic adjuvants. During our efforts to control his pain, the patient exhibited opioid-induced hyperalgesia, an uncommon but important phenomenon seen with high-dose opioid therapy. With appropriate opioid adjustment--in this case reduction of intrathecal morphine dosage by a factor of 100--the condition rapidly resolved and the patient became pain-free and remained so until his death six weeks later. The keys to identifying this uncommon, but treatable, opioid side effect are recognizing it as a possibility when aggressive efforts to control pain with high doses of opioids, especially when administered neuraxially, are met with increasing pain.
我们报告了一例转移性睾丸癌患者，其顽固性疼痛对大剂量口服、静脉注射及鞘内（IT）阿片类药物均无效，虽辅以镇痛佐剂仍难以缓解。在我们努力控制其疼痛的过程中，该患者出现了阿片类药物诱导的痛觉过敏，这是一种在大剂量阿片类药物治疗中虽不常见但很重要的现象。通过适当调整阿片类药物——在本病例中鞘内吗啡剂量减少了100倍——病情迅速得到缓解，患者不再疼痛，并一直保持无痛状态直至六周后去世。识别这种不常见但可治疗的阿片类药物副作用的关键在于，当使用大剂量阿片类药物，尤其是经神经轴给药积极控制疼痛却导致疼痛加剧时，要意识到存在这种可能性。
