Grond S, Zech D, Schug S A, Lynch J, Lehmann K A
J Pain Symptom Manage. 1991 Oct;6(7):411-22. doi: 10.1016/0885-3924(91)90039-7.
The efficacy of the World Health Organization's guidelines for cancer pain relief was examined in 401 dying patients. At the time of death, only 3% of the patients experienced severe or very severe pain; whereas 52% had no pain at all, 24% experienced only mild or moderate pain, and 20% were unable to rate their pain intensity. Analgesic drugs were the mainstay of therapy during the last 24 hr of life, being administered by mouth in 47% and parenterally in 44% of the patients. Only 9% of the patients required no systemic analgesics. Nonopioid analgesics alone were effective in 5% and a combination of nonopioids and "weak" opioids were effective in 16% of the patients. In the remaining 70% of the patients "strong" opioids alone or in combination with nonopioid analgesics were necessary to achieve adequate pain reduction. Additional adjuvant drugs to treat special types of pain or other symptoms were prescribed in 90% of the patients. Nonpharmacological measures, such as radiotherapy, nerve blocks or neurosurgery played only a very minor role at this stage of the disease. This study shows that cancer pain can be treated satisfactorily until death.
对401例临终患者研究了世界卫生组织癌症疼痛缓解指南的疗效。在死亡时，仅3%的患者经历重度或极重度疼痛；而52%的患者完全没有疼痛，24%的患者仅经历轻度或中度疼痛，20%的患者无法评定其疼痛强度。镇痛药是临终前24小时治疗的主要手段，47%的患者口服给药，44%的患者经肠外给药。仅9%的患者不需要全身性镇痛药。仅非阿片类镇痛药有效的患者占5%，非阿片类药与“弱”阿片类药联合有效的患者占16%。在其余70%的患者中，单独使用“强”阿片类药或与非阿片类镇痛药联合使用对于充分减轻疼痛是必要的。90%的患者还开具了用于治疗特殊类型疼痛或其他症状的辅助药物。在疾病的这个阶段，放疗、神经阻滞或神经外科手术等非药物措施仅起非常小的作用。这项研究表明，癌症疼痛直至死亡前都可得到满意治疗。
