Epstein J B, Elad S, Eliav E, Jurevic R, Benoliel R
Department of Oral Medicine and Diagnostic Sciences, MC-838, College of Dentistry, 801 S. Paulina St., Chicago, IL 60612, USA.
J Dent Res. 2007 Jun;86(6):506-18. doi: 10.1177/154405910708600605.
Cancer-associated pain is extremely common and is associated with significant physical and psychological suffering. Unfortunately, pain associated with cancer or its treatment is frequently under-treated, probably due to several factors, including phobia of opioids, under-reporting by patients, and under-diagnosis by healthcare workers. The most common etiology of cancer pain is local tumor invasion (primary or metastatic), involving inflammatory and neuropathic mechanisms; these have been reviewed in Part I. As malignant disease advances, pain usually becomes more frequent and more intense. Additional expressions of orofacial cancer pain include distant tumor effects, involving paraneoplastic mechanisms. Pain secondary to cancer therapy varies with the treatment modalities used: Chemo-radiotherapy protocols are typically associated with painful mucositis and neurotoxicity. Surgical therapies often result in nerve and tissue damage, leading, in the long term, to myofascial and neuropathic pain syndromes. In the present article, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. As a presenting symptom of orofacial cancer, pain is often of low intensity and diagnostically unreliable. Diagnosis, treatment, and prevention of pain in cancer require knowledge of the presenting characteristics, factors, and mechanisms involved.
癌症相关疼痛极为常见，会给患者带来巨大的身心痛苦。不幸的是，与癌症或其治疗相关的疼痛常常未得到充分治疗，这可能是由多种因素导致的，包括对阿片类药物的恐惧、患者报告不足以及医护人员诊断不足。癌症疼痛最常见的病因是局部肿瘤侵犯（原发性或转移性），涉及炎症和神经病理性机制；这些内容已在第一部分中进行了综述。随着恶性疾病的进展，疼痛通常会变得更加频繁和剧烈。口腔面部癌症疼痛的其他表现包括远处肿瘤效应，涉及副肿瘤机制。癌症治疗引起的疼痛因所采用的治疗方式而异：放化疗方案通常会导致疼痛性粘膜炎和神经毒性。手术治疗常常会导致神经和组织损伤，长期来看会引发肌筋膜和神经病理性疼痛综合征。在本文中，我们综述了癌症相关口腔面部疼痛在各个阶段的临床表现：初始诊断阶段、治疗期间（化疗、放疗、手术）以及治疗后阶段。作为口腔面部癌症的一个症状，疼痛强度往往较低，诊断价值不可靠。癌症疼痛的诊断、治疗和预防需要了解其呈现的特征、相关因素和机制。
