Winter E, Thoma R
Kankenhaus der Missions-Benediktinerinnen, Schmerabteilung, Tutzing.
MMW Fortschr Med. 2004 Mar 25;146(13):44-6, 48.
Patients experiencing constant pain continue to receive less than optimal treatment. In the case of cancer pain in particular, adequate therapy is a must. On the basis of the WHO analgesic ladder, nonopioids and opioids of varying potency must be applied as required, together with antiemetics, laxatives, gastric-protective preparations and bisphosphonates to ameliorate side effects. A particular problem in the treatment of cancer pain is the suddenly occurring stress and perforation pain. This can be reduced with fast-acting opioids such as the fentanyl stick. If the patient does not respond adequately to any of the noninvasive methods, local anesthetics and opiates applied via an i.v. pump system that permits bolus application and spinal and epidural methods have proven useful.
持续疼痛的患者所接受的治疗仍未达到最佳效果。特别是在癌症疼痛的情况下，充分的治疗是必不可少的。根据世界卫生组织的镇痛阶梯，必须根据需要使用不同效力的非阿片类药物和阿片类药物，同时使用止吐药、泻药、胃保护制剂和双膦酸盐来减轻副作用。癌症疼痛治疗中的一个特殊问题是突然出现的应激性和穿孔性疼痛。这可以通过使用速效阿片类药物如芬太尼棒来减轻。如果患者对任何非侵入性方法反应不佳，经静脉泵系统（允许推注给药）应用局部麻醉药和阿片类药物以及脊髓和硬膜外方法已被证明是有效的。
