Department of Anaesthesiology, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2009 Nov;38(11):989-97.
Cancer pain is complex and multifactorial. Most cancer pain can be effectively controlled using analgesics in accordance to the WHO analgesic ladder. However, in a small but significant percentage of cancer patients, systemic analgesics fail to provide adequate control of cancer pain. These cancer patients can also suffer from intolerable adverse effects of drug therapy or intractable cancer pain in advance disease. Though the prognosis of these cancer patients is often very limited, the pain relief, reduced medical costs and improvement in function and quality of life from a wide variety of available interventional procedures is extremely invaluable. These interventions can be used as sole agents or as useful adjuncts to supplement analgesics. This review will discuss interventional procedures such as epidural and intrathecal drug infusions, intrathecal neurolysis, sympathetic nervous system blockade, nerve blocks, vertebroplasty and the more invasive neurosurgical procedures. Intrathecal medications including opioids, local anaesthetics, clonidine, and ziconotide will also be discussed.
癌痛是复杂的、多因素的。大多数癌痛可以通过根据世界卫生组织（WHO）的镇痛阶梯使用镇痛药来有效控制。然而，在一小部分但数量相当可观的癌症患者中，全身用镇痛药无法充分控制癌痛。这些癌症患者还可能因药物治疗的不可耐受的不良反应或疾病进展期的难治性癌痛而受苦。尽管这些癌症患者的预后通常非常有限，但通过广泛的各种介入治疗程序可以获得缓解疼痛、降低医疗费用以及改善功能和生活质量，这些收益是极其宝贵的。这些介入可以作为单一治疗药物或作为镇痛药的辅助治疗药物。本综述将讨论介入性治疗方法，如硬膜外和鞘内药物输注、鞘内神经松解术、交感神经阻滞、神经阻滞、椎体成形术和更具侵袭性的神经外科手术。还将讨论鞘内药物，包括阿片类药物、局部麻醉剂、可乐定和齐考诺肽。
