Jacob Eufemia
Baylor College of Medicine, Texas Children's Cancer Center, Houston 77030, USA.
J Pediatr Oncol Nurs. 2004 Nov-Dec;21(6):350-7. doi: 10.1177/1043454204270251.
Different mechanisms of cancer pain may involve somatic, visceral, and neural tissues. Pain that involves the neural tissues is classified as neuropathic pain and is less responsive to analgesics than pain that involves somatic and visceral tissues. Because young children are unable to describe the quality of pain, presence of neuropathic pain with cancer may be unrecognized and undetected. The purpose of this article is to explain the nature of neuropathic pain, to review the literature related to children with cancer that suggests the presence of neuropathic pain, to outline assessment strategies that may lead to appropriate detection of neuropathic pain in children, and to discuss challenges in the management of neuropathic pain. Future research is needed to characterize the intensity, location, quality, and duration of neuropathic pain in children. In addition, research that would determine the efficacy of opioids, nonsteroidal anti-inflammatory drugs, and adjuvant analgesics (antidepressants, anticonvulsants) is needed to increase the nurses' ability to assess and manage neuropathic pain in children with cancer.
癌症疼痛的不同机制可能涉及躯体、内脏和神经组织。涉及神经组织的疼痛被归类为神经性疼痛，与涉及躯体和内脏组织的疼痛相比，对镇痛药的反应较差。由于幼儿无法描述疼痛的性质，癌症伴发的神经性疼痛可能未被识别和检测到。本文的目的是解释神经性疼痛的本质，回顾与癌症患儿相关的文献，这些文献提示存在神经性疼痛，概述可能有助于适当检测儿童神经性疼痛的评估策略，并讨论神经性疼痛管理中的挑战。未来需要开展研究来明确儿童神经性疼痛的强度、位置、性质和持续时间。此外，需要开展研究以确定阿片类药物、非甾体抗炎药和辅助镇痛药（抗抑郁药、抗惊厥药）的疗效，以提高护士评估和管理癌症患儿神经性疼痛的能力。
