Shibahara Hiroaki, Ando Akira, Suzuki Shingo, Uematsu Natsuko, Nishimura Daisaku
Department of Palliative Care, Toyota Kosei Hospital, Japan.
Gan To Kagaku Ryoho. 2011 Oct;38(10):1675-7.
This paper presents a man in his 70's with non-small cell lung cancer (cT3N2M0, Stage III A) after chemoradiation therapy during follow-up visits. He was referred to the department of palliative care 1 month after the occurrence of herpes zoster, because of pain. Opioids (transdermal fentanyl patch and rapid-release oxycodone) were administered for his cancer pain previously. Additionally, gabapentin was given for neuropathic pain uncontrolled by opioids. However, this was replaced by pregabalin because he experienced somnolence. Although numbing improved remarkably with pregabalin, the pain was only slightly improved. The dose of rapid-release oxycodone was increased and controlled-release oxycodone was added. This provided for marked pain relief. We conclude that administration of pregabalin as an analgesic adjuvant, and oxycodone, which is an opioid, should be considered in the treatment of cancer patients without improvement of neuropathic pain from herpes zoster through use of the transdermal fentanyl patch.
本文介绍了一名70多岁的男性，在接受放化疗后随访期间被诊断为非小细胞肺癌（cT3N2M0，ⅢA期）。带状疱疹发作1个月后，因疼痛被转诊至姑息治疗科。此前已使用阿片类药物（透皮芬太尼贴剂和即释羟考酮）治疗其癌痛。此外，还给予加巴喷丁治疗阿片类药物无法控制的神经性疼痛。然而，由于他出现嗜睡症状，加巴喷丁被普瑞巴林替代。尽管使用普瑞巴林后麻木感明显改善，但疼痛仅略有缓解。即释羟考酮的剂量增加，并添加了控释羟考酮。这使得疼痛得到了显著缓解。我们得出结论，对于使用透皮芬太尼贴剂治疗带状疱疹后神经性疼痛无改善的癌症患者，应考虑使用普瑞巴林作为镇痛辅助药物，并使用阿片类药物羟考酮进行治疗。
