Department of Palliative Medicine, Poznań University of Medical Sciences, Osiedle Rusa 25 A, PL 61-245 Poznań, Poland.
Pharmacol Rep. 2009 Nov-Dec;61(6):978-92. doi: 10.1016/s1734-1140(09)70159-8.
In most cancer patients, pain is successfully treated with pharmacological measures such as opioid analgesics alone or opioid analgesics combined with adjuvant analgesics (co-analgesics). Opioids for mild-to-moderate pain (formerly called weak opioids) are usually recommended in the treatment of cancer pain of moderate intensity. There is a debate whether the second step of the WHO analgesic ladder, which, in Poland, is composed of opioids such as tramadol, codeine, dihydrocodeine (DHC), is still needed for cancer pain treatment. One of the most interesting and useful drugs in this group is tramadol. Its unique mechanism of action, analgesic efficacy and profile of adverse effects are responsible for its successful use in patients with different types of acute and chronic pain, including neuropathic pain. The aim of this article is to summarize the data regarding pharmacodynamics, pharmacokinetics, possible drug interactions, adverse effects, dosing guidelines, equipotency with other opioid analgesics and clinical studies comparing efficacy, adverse reactions and safety of tramadol to other opioids in cancer pain treatment.
在大多数癌症患者中，疼痛可以通过单独使用阿片类镇痛药或阿片类镇痛药联合辅助镇痛药（协同镇痛药）等药理学措施成功治疗。对于轻至中度疼痛（以前称为弱阿片类药物）的治疗，通常推荐使用阿片类药物。对于癌症中度疼痛的治疗，是否仍需要使用世界卫生组织镇痛阶梯的第二步（在波兰，第二步由曲马多、可待因、二氢可待因（DHC）等阿片类药物组成），这在学术界存在争议。在该类药物中，曲马多是最有趣和最有用的药物之一。其独特的作用机制、镇痛疗效和不良反应特征使其能够成功用于治疗各种类型的急性和慢性疼痛，包括神经性疼痛。本文的目的是总结有关曲马多的药效学、药代动力学、可能的药物相互作用、不良反应、剂量指南、与其他阿片类镇痛药的等效性以及与其他阿片类药物比较治疗癌症疼痛的疗效、不良反应和安全性的临床研究数据。
