Rana Sps, Gupta Rahul, Chaudhary Prakash, Khurana Deepa, Mishra Seema, Bhatnagar Sushma
Department of Unit of Anaesthesiology (IRCH), Dr. BRA IRCH, AIIMS, New Delhi, India.
Indian J Palliat Care. 2011 May;17(2):127-30. doi: 10.4103/0973-1075.84533.
Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.
癌症疼痛是多因素且复杂的。如果得不到充分治疗，癌症疼痛的影响是毁灭性的，会导致发病率增加和生活质量下降。由于疾病进程以及治疗相关副作用，癌症疼痛管理是一项具有挑战性的任务。使用口服阿片类药物、辅助镇痛药和先进的疼痛管理技术优化镇痛是癌症疼痛治疗成功的关键。早期使用口服阿片类药物和介入性疼痛管理技术可以克服癌症疼痛的障碍，提高生活质量。通过及时、适当的抗癌治疗、阿片类药物、神经阻滞以及心理社会护理等其他非侵入性技术，大多数患者可以实现满意的疼痛缓解。尽管世界卫生组织的镇痛阶梯对80%以上的癌症疼痛有效，但为了提高生活质量，还需要添加适当的辅助药物并进行早期干预。有效的癌症疼痛治疗需要一种整体方法，包括及时评估、疼痛测量、引起特定类型疼痛的病理生理学以及对缓解疼痛药物的了解，并及时纳入干预措施。通过良好的沟通仔细评估心理社会和精神因素是必要的。应采用多学科方法克服癌症疼痛管理的障碍，旨在提供充分的镇痛且副作用最小。癌症疼痛管理不仅应包括身体方面，还应包括患者的心理社会、精神和社会需求。通过风险效益分析，介入技术应在疼痛治疗的早期阶段就被纳入。本文总结了早期和有效的疼痛管理策略的必要性、对疼痛控制的认识以及癌症疼痛的障碍。
