University of Texas, MD Anderson Cancer Center, Dept. of Anesthesiology & Pain Medicine, Unit 409, 1400 Holcombe Blvd, Houston TX 77030-0409, USA.
Pain Physician. 2011 Jul-Aug;14(4):E361-71.
The growing awareness of opioid abuse and addiction in the chronic pain population, along with increasing cancer survivorship, has heightened our awareness of this potential problem in the cancer patient. An increasing number of patients who abuse opioids have been identified in our clinical setting.
We present an algorithm of multidisciplinary care for the treatment of cancer patients at risk for abusing opioids.
Two illustrative patient examples were identified recently from our clinic.
These 2 patient examples demonstrate our multidisciplinary approach to treatment. A discussion of safe prescribing principles adapted from the literature is presented. Also, a brief point of added complexity is introduced; specifically, ethical considerations due to the unique nature of cancer pain.
Although validation studies exist for the use of screening tools in patients with chronic noncancer pain, there have been no instrument validation studies on patients with cancer pain. The educational treatment model that we refer to regarding facilitating safe use of opioids also has not been studied on patients with cancer pain. Lastly, we express caution in generalizing our guidelines to patients with noncancer pain. Our patient population differs in the multiple co-existing stressors and symptom burden associated with cancer.
We have become increasingly aware of the problem of opioid abuse in the cancer pain population. With an approach to using safe prescribing principles adapted from chronic pain literature, and an ethically based multidisciplinary approach, clinicians can continue to treat pain successfully in the opioid-misusing cancer patient. We outline our approach in this article.
慢性疼痛人群中阿片类药物滥用和成瘾意识的增强，以及癌症存活率的提高，使我们意识到癌症患者存在这种潜在问题。在我们的临床环境中，越来越多的滥用阿片类药物的患者被发现。
我们提出了一种多学科护理的算法，用于治疗有滥用阿片类药物风险的癌症患者。
最近从我们的诊所确定了两个说明性的患者示例。
这 2 个患者示例展示了我们的多学科治疗方法。讨论了从文献中改编的安全处方原则。此外，还介绍了一个简要的复杂问题点；具体来说，由于癌症疼痛的独特性质，涉及到伦理考虑。
尽管有用于慢性非癌性疼痛患者的筛选工具使用的验证研究，但尚未有针对癌症疼痛患者的工具验证研究。我们提到的关于促进阿片类药物安全使用的教育治疗模式也尚未在癌症疼痛患者中进行研究。最后，我们在将我们的指南推广到非癌症疼痛患者时要谨慎。我们的患者群体在与癌症相关的多种共存压力源和症状负担方面存在差异。
我们越来越意识到癌症疼痛人群中阿片类药物滥用的问题。通过采用从慢性疼痛文献改编的安全处方原则，并采用基于伦理的多学科方法，临床医生可以继续成功地治疗滥用阿片类药物的癌症患者的疼痛。我们在本文中概述了我们的方法。
