Mercadante Sebastiano, Fulfaro Fabio
Anesthesia & Intensive Care Unit - La Maddalena Cancer Center, University of Palermo, Palermo, Italy.
Curr Opin Oncol. 2007 Jul;19(4):308-14. doi: 10.1097/CCO.0b013e3281214400.
This review examines recent data on the pathophysiology and mechanisms of bone pain; it highlights the use of multiple and interdisciplinary treatments rather than sole use of traditional analgesics.
Bone pain has been shown to have a unique pathophysiology. Recent experimental (animal) models have revealed that, parallel to increased bone destruction, ipsilateral spinal cord segments that receive primary input from the cancerous femur exhibit several notable neurochemical changes. These mandate the use of opioid doses sufficient to inhibit the observed nociceptive behaviours; these doses are greater than those required to alleviate pain behaviours of comparable magnitude generated by inflammatory pain. Several substances have been tested in this animal model.
According to new preclinical data, treatment of bone cancer pain requires multidisciplinary therapies such as radiotherapy applied to the painful area along with systemic treatment (hormone therapy or chemotherapy) and supportive care (analgesic therapy and bisphosphonates). In some selected cases use of radioisotopes and other noninvasive or minimally invasive techniques may be useful in the management of metastatic bone pain. The treatment should be individualized according to the patient's clinical condition, life expectancy, and quality of life.
本综述探讨了近期关于骨痛病理生理学和机制的数据；强调了采用多种跨学科治疗方法，而非单纯使用传统镇痛药。
已证实骨痛具有独特的病理生理学。近期的实验（动物）模型显示，与骨破坏增加同时发生的是，接受来自癌性股骨初级传入的同侧脊髓节段呈现出一些显著的神经化学变化。这些变化要求使用足以抑制观察到的伤害性反应行为的阿片类药物剂量；这些剂量大于缓解由炎性疼痛产生的同等程度疼痛行为所需的剂量。在该动物模型中已对几种物质进行了测试。
根据新的临床前数据，骨癌疼痛的治疗需要多学科疗法，如对疼痛部位进行放射治疗，同时进行全身治疗（激素治疗或化疗）以及支持治疗（镇痛治疗和双膦酸盐类药物）。在某些特定病例中，使用放射性同位素及其他非侵入性或微创技术可能有助于转移性骨痛的管理。治疗应根据患者的临床状况、预期寿命和生活质量进行个体化。
