Sumitani Masahiko, Yamada Yoshitsugu
Dept. of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital.
Gan To Kagaku Ryoho. 2011 Jun;38(6):977-82.
Cancer-related pain has a wide variety of pathophysiologies. It is well known that many cancer patients suffer from visceral pain, neuropathic pain and bone pain, not only during the terminal phase but also in the active treatment phase. In general, opioids are highly effective against cancer-related pain. It is essential that opioids be selected appropriately based on the pathophysiology of pain, since the analgesic properties of opioids are not homogeneous;the sensitivities of each opioid on neuropathic pain and bone pain differ markedly. In clinical practice, it is also important that potential adverse effects of opioids are taken into account carefully. It has been demonstrated that oxycodone has favorable analgesic potency against neuropathic pain of both malignant and non-malignant origin, such as chemotherapy-induced peripheral neuropathic pain;however, we should be extremely cautious so as to avoid abuse and addiction to opioids when they are prescribed in the active treatment phase. Oxycodone could be effective on refractory bone pain that has a complicated pathophysiological mechanism. Furthermore, it has been reported that oxycodone may have a superior safety profile compared to morphine. Taking these characteristics into consideration, it appears that oxycodone is suitable as a first-line medication for the management of cancer-related pain that comes in a wide variety of pathophysiologies.
癌症相关疼痛具有多种病理生理学机制。众所周知，许多癌症患者不仅在终末期，而且在积极治疗阶段都会遭受内脏痛、神经病理性疼痛和骨痛。一般来说，阿片类药物对癌症相关疼痛非常有效。由于阿片类药物的镇痛特性并非同质化，基于疼痛的病理生理学机制适当选择阿片类药物至关重要；每种阿片类药物对神经病理性疼痛和骨痛的敏感性差异显著。在临床实践中，仔细考虑阿片类药物的潜在不良反应也很重要。已证明羟考酮对恶性和非恶性来源的神经病理性疼痛，如化疗引起的周围神经病理性疼痛，具有良好的镇痛效力；然而，在积极治疗阶段开具阿片类药物处方时，我们应极其谨慎，以避免滥用和成瘾。羟考酮对具有复杂病理生理机制的难治性骨痛可能有效。此外，据报道，与吗啡相比，羟考酮可能具有更好的安全性。考虑到这些特性，羟考酮似乎适合作为一线药物用于管理具有多种病理生理学机制的癌症相关疼痛。
