Radbruch L, Elsner F
Klinik für Palliativmedizin, RWTH Aachen.
Internist (Berl). 2005 Oct;46(10):1105-14. doi: 10.1007/s00108-005-1442-5.
Cancer pain treatment should follow the recommendations of the World Health Organisation. Treatment should be with oral application, regular application times and following the analgesic step-ladder. Non-opioids such as dipyrone or non-steroids are used for slight to moderate pain, step-2 opioids such as tramadol or tilidine/naloxone for moderate pain and step-3 opioids such as morphine, oxycodone or hydromorphone for severe pain. Transdermal application of fentanyl or buprenorphine offer a non-invasive parenteral alternative for patients with stable pain syndromes. Cannabinoids such as tetrahydrocannabinol offer a valuable add-on option for cancer patients with refractory pain, spasticity, nausea or appetite loss.
癌症疼痛治疗应遵循世界卫生组织的建议。治疗应采用口服给药、固定给药时间，并遵循镇痛阶梯疗法。对于轻度至中度疼痛，使用如安乃近或非甾体类药物等非阿片类药物；对于中度疼痛，使用如曲马多或替利定/纳洛酮等第二阶梯阿片类药物；对于重度疼痛，使用如吗啡、羟考酮或氢吗啡酮等第三阶梯阿片类药物。芬太尼或丁丙诺啡的透皮贴剂为疼痛症状稳定的患者提供了一种非侵入性的胃肠外给药替代方式。诸如四氢大麻酚等大麻素类药物为患有难治性疼痛、痉挛、恶心或食欲减退的癌症患者提供了一种有价值的附加治疗选择。
