Hanks G W
Department of Palliative Medicine, United Medical School, Guy's Hospital, London, UK.
Br Med Bull. 1991 Jul;47(3):718-31. doi: 10.1093/oxfordjournals.bmb.a072503.
Cancer pain in general responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment, successfully controlling pain in 70-90% of patients. The two major problem areas are pain associated with nerve damage, and 'incident' (movement-related) bone pain. Nerve damage pain tends not to respond well to morphine or other opioids. The difficulty with severe incident pain is that if the dose of opioid is titrated sufficiently to relieve the pain on weight-bearing or on movement and is then given regularly at this level, it is too much for the patient at rest. The patient may then experience excessive side-effects at rest, but still have pain on movement. Other examples of pain which may be resistant to treatment with opioid analgesics are bladder and rectal tenesmus, pancreatic pain, and pain associated with decubitus ulcers or other superficial ulcers subjected to pressure or shearing forces. Management of non-opioid-responsive pain may include a variety of treatments involving adjuvant analgesic drugs and non-drug measures.
一般来说，癌痛对镇痛药的反应具有可预测性，药物治疗是主要的治疗手段，能成功控制70%至90%患者的疼痛。两个主要问题领域是与神经损伤相关的疼痛以及“偶发性”（与活动相关）骨痛。神经损伤性疼痛往往对吗啡或其他阿片类药物反应不佳。严重偶发性疼痛的难点在于，如果将阿片类药物剂量滴定至足以缓解负重或活动时的疼痛，然后在此水平定期给药，对于静息状态的患者来说剂量就过大了。患者在静息时可能会出现过多副作用，但活动时仍会疼痛。其他可能对阿片类镇痛药治疗有抵抗性的疼痛例子包括膀胱和直肠绞痛、胰腺疼痛以及与褥疮或其他受压力或剪切力影响的浅表溃疡相关的疼痛。对非阿片类药物反应性疼痛的管理可能包括多种涉及辅助镇痛药和非药物措施的治疗方法。
