Meera Agar
Senior lecturer, Discipline of Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Director of Palliative Care, Braeside Hospital, Hammond Care, Sydney, New South Wales, Conjoint Associate Professor, Sydney South West Clinical School, University of New South Wales, Sydney, Australia, Staff Specialist - Research, Sydney South West Area Palliative Care Service, Sydney, New South Wales, Australia.
Indian J Palliat Care. 2011 Jan;17(Suppl):S36-8. doi: 10.4103/0973-1075.76240.
Opioids are extremely effective in managing cancer pain, and now are utilized for longer periods of time in cancer patients as the treatment for malignancies has become more successful.[1] The goals in cancer pain treatment includes maintaining function in patients with cancer pain (especially in earlier stage disease), and palliation in advanced disease.[1] The perception of the lay public and inexperienced clinicians that addiction is inevitable, often leads to an inappropriate fear to utilize opioids to appropriately manage pain; resulting in persistent under-treatment of cancer pain internationally.[23] There is much confusion about the phenomenon of physical dependence and how this can be differentiated from the maladaptive behaviors that constitute a diagnosis of substance abuse. The burden of cancer and associated cancer pain is projected to continue to rise, and is often at an advanced stage at diagnosis in less developed countries.[4] To be able to provide quality care for this patient population availability of opioids and skilled clinicians in pain management is paramount. In the majority of cases, the main concern is to abate concerns about risks of opioid addiction; to allow adequate pain relief. To understand the infrequent phenomenon of substance abuse in the setting of cancer pain management clear definitions are needed, and review of the epidemiology of occurrence in cancer populations is needed. It is also important to clearly separate the issues of substance abuse at the patient level and diversion of prescribed opioids. There are principles of managing cancer pain in the rare clinical scenario when the risk of substance abuse is high, which can still allow safe management of cancer pain with opioids.
阿片类药物在控制癌症疼痛方面极为有效，并且随着癌症治疗变得更加成功，现在在癌症患者中使用的时间更长。[1]癌症疼痛治疗的目标包括维持癌症疼痛患者的功能（尤其是在疾病早期），以及缓解晚期疾病的疼痛。[1]普通公众和经验不足的临床医生认为成瘾不可避免，这往往导致对使用阿片类药物适当控制疼痛产生不当恐惧；从而在国际上导致癌症疼痛持续治疗不足。[23]对于身体依赖现象以及如何将其与构成药物滥用诊断的适应不良行为区分开来，存在很多困惑。预计癌症负担和相关癌症疼痛将继续上升，并且在欠发达国家，癌症往往在诊断时就已处于晚期。[4]为了能够为这一患者群体提供优质护理，阿片类药物的可及性和疼痛管理方面的熟练临床医生至关重要。在大多数情况下，主要关注点是消除对阿片类药物成瘾风险的担忧；以实现充分的疼痛缓解。为了理解癌症疼痛管理中罕见的药物滥用现象，需要明确的定义，并对癌症人群中发生情况的流行病学进行回顾。明确区分患者层面的药物滥用问题和处方阿片类药物的转移问题也很重要。在药物滥用风险很高的罕见临床情况下，有管理癌症疼痛的原则，这仍然可以实现使用阿片类药物安全管理癌症疼痛。
