Vecht C J, Hoff A M, Kansen P J, de Boer M F, Bosch D A
Department of Neurology, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Cancer. 1992 Jul 1;70(1):178-84. doi: 10.1002/1097-0142(19920701)70:1<178::aid-cncr2820700128>3.0.co;2-e.
In a series of 25 patients with head and neck cancer who had severe pain, the type and cause of the pain were analyzed. There were two types of pain: nociceptive and non-nociceptive. Nineteen (76%) patients had nociceptive pain that could be subdivided into actual nociceptive pain (9 patients), nociceptive nerve pain (8 patients), or referred pain (2 patients). The cause of nociceptive pain was secondary to tumor recurrence in 16 patients and secondary to benign inflammation in 3 patients. Of the six (23%) cases of non-nociceptive pain, all were diagnosed as neuropathic pain secondary to the sequels of neck dissection. World Health Organization guidelines were applied for the treatment of symptomatic pain of nociceptive pain; if necessary, nerve blocks were used after this treatment. Non-nociceptive pain was usually treated with amitriptyline or carbamazepine. If tumor recurrence was the cause of the pain, antitumor-directed therapy was applied, when possible. Relief was achieved in 52% of the patients after two attempts to treat pain, in 64% after three attempts, and in up to 72% after four attempts. Pain could not be controlled in 28% of the patients. Patients with tumor recurrence had a short median survival time of 3 months, regardless of pain control. Patients with neuropathic pain had a survival time of 16 months or more (median not reached). The authors conclude that the type and cause of the pain in cancer of the head and neck can be determined; this can lead to the administration of proper symptomatic therapy or treatment directed at the underlying cause. In most cases, several successive attempts to treat pain were made before relief was achieved.
在一系列25例患有严重疼痛的头颈癌患者中，对疼痛的类型和原因进行了分析。疼痛有两种类型：伤害感受性疼痛和非伤害感受性疼痛。19例（76%）患者有伤害感受性疼痛，可细分为实际伤害感受性疼痛（9例）、伤害感受性神经痛（8例）或牵涉痛（2例）。伤害感受性疼痛的原因在16例患者中是继发于肿瘤复发，3例患者中是继发于良性炎症。在6例（23%）非伤害感受性疼痛病例中，均被诊断为颈部清扫术后后遗症继发的神经性疼痛。应用世界卫生组织的指南来治疗伤害感受性疼痛的症状性疼痛；如有必要，在该治疗后使用神经阻滞。非伤害感受性疼痛通常用阿米替林或卡马西平治疗。如果肿瘤复发是疼痛的原因，则尽可能应用针对肿瘤的治疗。在两次尝试治疗疼痛后，52%的患者疼痛得到缓解，三次尝试后为64%，四次尝试后高达72%。28%的患者疼痛无法得到控制。无论疼痛是否得到控制，肿瘤复发的患者中位生存时间较短，为3个月。神经性疼痛的患者生存时间为16个月或更长（未达到中位值）。作者得出结论，头颈癌疼痛的类型和原因可以确定；这可以导致给予适当的对症治疗或针对潜在病因的治疗。在大多数情况下，在疼痛得到缓解之前进行了几次连续的疼痛治疗尝试。
