Lussier David, Huskey Angela G, Portenoy Russell K
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, First Avenue at 16th Street, New York, New York 10003, USA.
Oncologist. 2004;9(5):571-91. doi: 10.1634/theoncologist.9-5-571.
Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, alpha(2)-adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions.
辅助镇痛药被定义为主要适应症不是疼痛，但在某些疼痛状况下具有镇痛特性的药物。该类别包括众多不同种类的药物。尽管这些药物在慢性非恶性疼痛综合征中作为一线药物广泛使用，这表明“辅助”一词用词不当，但在用于癌症疼痛治疗时，它们通常与效果欠佳的阿片类药物方案联合使用。一些辅助镇痛药在多种疼痛状况下都有用，被描述为多用途辅助镇痛药（抗抑郁药、皮质类固醇、α₂肾上腺素能激动剂、抗精神病药），而其他一些则对神经性疼痛（抗惊厥药、局部麻醉药、N-甲基-D-天冬氨酸受体拮抗剂）、骨痛（降钙素、双膦酸盐、放射性药物）、肌肉骨骼疼痛（肌肉松弛剂）或肠梗阻引起的疼痛（奥曲肽、抗胆碱能药）具有特异性。本文综述了支持各类辅助镇痛药用于治疗癌症患者疼痛的证据，并提供了给药建议、副作用和药物相互作用的全面概述。
