Mori Masanori, Elsayem Ahmed, Reddy Suresh K, Bruera Eduardo, Fadul Nada A
Department of Hematology and Oncology, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, USA.
Am J Hosp Palliat Care. 2012 May;29(3):236-40. doi: 10.1177/1049909111415511. Epub 2011 Jul 22.
Even with specialist-level palliative care, cancer pain can be difficult to treat especially when the pain is complicated by profound suffering. It is paramount to consider not only the patients' biochemical factors but also their psychosocial and spiritual/existential influences. A multidimensional approach with knowledge of the risk factors for poor pain control is important to prevent, detect, and manage risk factors for intractable pain, including psychosocial distress, addictive behavior, and delirium in patients with terminal cancer. We present 3 cases of patients with advanced cancer with intractable bone pain whose hospital courses were complicated by severe psychosocial distress and delirium. We also propose an algorithm of multidimensional approach to unrelieved pain and suffering in patients with advanced cancer.
即使采用专科水平的姑息治疗，癌症疼痛也可能难以治疗，尤其是当疼痛因严重痛苦而变得复杂时。不仅要考虑患者的生化因素，还要考虑他们的心理社会和精神/生存影响，这至关重要。采用多维方法并了解疼痛控制不佳的风险因素，对于预防、检测和管理顽固性疼痛的风险因素很重要，这些因素包括晚期癌症患者的心理社会困扰、成瘾行为和谵妄。我们介绍了3例晚期癌症伴顽固性骨痛的患者，他们的住院过程因严重的心理社会困扰和谵妄而变得复杂。我们还提出了一种针对晚期癌症患者未缓解疼痛和痛苦的多维方法算法。
