Portenoy R K, Coyle N
J Pain Symptom Manage. 1990 Oct;5(5):307-19. doi: 10.1016/0885-3924(90)90047-n.
The management of pain in the patient with advanced cancer requires comprehensive assessment and expertise in the application of many therapeutic techniques. Given the complexity of the problems posed by these patients, it is not surprising that most aspects of palliative care derive from personal anecdote and clinical consensus, rather than well-defined guidelines based on research findings. In the absence of such guidelines, unresolved issues and controversies abound. This review discusses some of the most important of these topics, which range from the overall system of care and quality of assessment to the specifics of pharmacotherapy and other modalities of treatment. In so doing, the rationale for some of the accepted clinical approaches can be clarified, others that are as yet little known can be highlighted, and the issues most in need of further investigation can be defined.
晚期癌症患者的疼痛管理需要进行全面评估，并具备应用多种治疗技术的专业知识。鉴于这些患者所带来问题的复杂性，姑息治疗的大多数方面源自个人经验和临床共识，而非基于研究结果的明确指南，这并不令人惊讶。在缺乏此类指南的情况下，未解决的问题和争议比比皆是。本综述讨论了其中一些最重要的主题，涵盖从整体护理系统和评估质量到药物治疗及其他治疗方式的具体细节。这样做可以阐明一些公认临床方法的基本原理，突出其他一些尚不为人所知的方法，并确定最需要进一步研究的问题。
