Okon Tomasz
Department of Palliative Medicine, Marshfield Clinic, Marshfield, WI 54449, USA.
Pain Physician. 2007 May;10(3):493-500.
A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented.
本文介绍了一名患有冷球蛋白血症、血管炎和严重皮肤溃疡的患者，其慢性顽固性疼痛不断升级的病史。描述了一种逐步采用多种药物阻断N-甲基-D-天冬氨酸受体（NMDA-R）的策略，该策略实现了充分的疼痛控制，并使阿片类药物的消耗量减少了三倍。简要回顾了神经性疼痛的诊断过程以及NMDA-R在痛觉过敏发展中的作用。此后，回顾了现有描述使用氯胺酮（一种主要的NMDA-R拮抗剂，用于治疗恶性疼痛）的临床文献。最后，提出了基于证据的静脉注射辅助氯胺酮治疗重度癌痛的原始方案。
