Finkel Julia C, Pestieau Sophie R, Quezado Zenaide M N
Division of Anesthesiology and Pain Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010, USA.
J Pain. 2007 Jun;8(6):515-21. doi: 10.1016/j.jpain.2007.02.429. Epub 2007 Apr 16.
In children with advanced stages of cancer, pain control remains inadequate in many patients and a solution to this problem is sorely lacking. Factors related to progression of the primary disease and side-effects of high doses of opioids, the mainstay of pain therapy, contribute to the inadequacy of pain control. In addition, few studies suggest that opioids, by inducing tolerance, having pronociceptive effects and producing hyperalgesia in some patients, can also contribute to inadequacy of pain control. Researchers have shown that N-methyl-D-aspartate (NMDA) receptor antagonists may have a role in mitigating opioid-induced tolerance and hyperalgesia in adults. However, literature on NMDA antagonists to treat cancer pain in children and adolescents is scarce. We used subanesthetic doses of ketamine to treat 11 children and adolescents who were on high doses of opioids and yet had uncontrolled cancer pain. A low-dose ketamine infusion was administered to all patients to modulate the need for rapidly escalating opioid therapy. We found that in 8 of 11 patients, ketamine infusions used as an adjuvant to opioid analgesia was associated with opioid-sparing effects and apparent improvement in pain control and in the children's ability to interact with their family. This study suggests that infusions of ketamine may offer a promising therapeutic option in the treatment of appropriately selected children and adolescents with intractable cancer pain.
In many children with advanced stages of cancer, pain control remains inadequate. We used subanesthetic doses of ketamine to treat 11 children and adolescents who were on high doses of opioids and had uncontrolled cancer pain. In the majority of patients, ketamine appeared to improve pain control and to have an opioid-sparing effect.
在患有晚期癌症的儿童中，许多患者的疼痛控制仍然不足，而解决这一问题的方法严重缺乏。与原发性疾病进展和高剂量阿片类药物（疼痛治疗的主要手段）的副作用相关的因素导致了疼痛控制的不足。此外，很少有研究表明，阿片类药物通过诱导耐受性、产生痛觉过敏效应以及在某些患者中引起痛觉过敏，也会导致疼痛控制不足。研究人员表明，N-甲基-D-天冬氨酸（NMDA）受体拮抗剂可能在减轻成人阿片类药物引起的耐受性和痛觉过敏方面发挥作用。然而，关于NMDA拮抗剂治疗儿童和青少年癌症疼痛的文献很少。我们使用亚麻醉剂量的氯胺酮治疗11名高剂量使用阿片类药物但癌症疼痛仍未得到控制的儿童和青少年。对所有患者进行低剂量氯胺酮输注，以调节快速增加阿片类药物治疗的需求。我们发现，在11名患者中的8名患者中，氯胺酮输注作为阿片类镇痛的辅助手段与阿片类药物节省效应以及疼痛控制和儿童与家人互动能力的明显改善有关。这项研究表明，氯胺酮输注可能为治疗适当选择的患有顽固性癌症疼痛的儿童和青少年提供一种有前景的治疗选择。
在许多患有晚期癌症的儿童中，疼痛控制仍然不足。我们使用亚麻醉剂量的氯胺酮治疗11名高剂量使用阿片类药物且癌症疼痛未得到控制的儿童和青少年。在大多数患者中，氯胺酮似乎改善了疼痛控制并具有阿片类药物节省效应。
