Panerai A E, Bianchi M, Sacerdote P, Ripamonti C, Ventafridda V, De Conno F
Department of Pharmacology, School of Medicine, University of Milan, Italy.
J Palliat Care. 1991 Winter;7(4):42-4.
Studies conducted in recent years have helped define the role of antidepressant drugs in the management of cancer pain. The antinociceptive action of these agents seems to be independent of beneficial effect on depression or mood. Among antidepressant drugs, those of the tricyclic class are preferred when an analgesic effect is sought. Their primary application is for pain due to nerve injury, so-called "neuropathic pain". Although the co-administration of tricyclic antidepressants may increase plasma morphine concentrations, any potentiation of morphine analgesia is thought not to be due to an increased bioavailability of the opiate, but to an intrinsic analgesic effect of antidepressants. On this basis, the use of antidepressants in combination with opioids for the treatment of cancer pain is suitable when a component of deafferentation is present or when there is concomitant depressive illness.
近年来开展的研究有助于明确抗抑郁药物在癌症疼痛管理中的作用。这些药物的抗伤害感受作用似乎独立于对抑郁或情绪的有益影响。在抗抑郁药物中，当寻求镇痛效果时，三环类药物更为可取。它们主要用于治疗因神经损伤引起的疼痛，即所谓的“神经性疼痛”。尽管三环类抗抑郁药与吗啡联合使用可能会提高血浆吗啡浓度，但吗啡镇痛作用的任何增强被认为并非由于阿片类药物生物利用度的提高，而是由于抗抑郁药本身的镇痛作用。在此基础上，当存在去传入神经成分或伴有抑郁症时，联合使用抗抑郁药和阿片类药物治疗癌症疼痛是合适的。
