Anesthesia and Intensive Care Unit, Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
Intern Emerg Med. 2010 Oct;5 Suppl 1:S31-5. doi: 10.1007/s11739-010-0448-8.
In the last decades, studies validating the WHO analgesic ladder have been shown to have methodological limitations and different problems are unresolved due to a lack of controlled studies on this subject. These problems include a better definition of the role of NSAIDs, the prolonged use of NSAIDs in cancer pain, and the utility of step 2. Moreover, the indications for using different strong opioids and alternate routes of administration to improve pain relief in difficult pain situations are not well established. The proportion of patients who do not benefit from these treatments remain unclear, and how the opioid response may be improved with the use of adjuvants is also uncertain. This review will offer an update on these problems and the existing therapeutic opportunities.
在过去的几十年中，已经有研究验证了世界卫生组织（WHO）的镇痛阶梯，但这些研究存在方法学上的局限性，并且由于缺乏对此主题的对照研究，仍存在一些未解决的问题。这些问题包括 NSAIDs 的作用需要更好地定义，NSAIDs 在癌症疼痛中的长期使用，以及第 2 步的实用性。此外，使用不同强效阿片类药物和其他给药途径来改善困难疼痛情况下的镇痛效果的适应症尚未明确。对于这些治疗方法没有获益的患者比例尚不清楚，并且使用辅助药物如何改善阿片类药物的反应也不确定。这篇综述将提供这些问题和现有治疗机会的最新信息。
