Shibahara Hiroaki, Okubo Kenji, Takeshita Nagayuki, Nishimura Daisaku
Dept. of Palliative Care, Toyota Kosei Hospital, Japan.
Gan To Kagaku Ryoho. 2012 Feb;39(2):277-80.
This paper presents the case of a man in his 60's with advanced esophageal cancer after the first course of 5-FU/CDDP therapy during follow-up visit, who had pain and numbness from right scapula to upper arm. MRI revealed bone metastasis in the first thoracic vertebra and lymph node metastasis to be diagnosed as neuropathic pain by brachial plexus invasion. Radiation therapy and medical treatment with lornoxicam and controlled-release oxycodone started. However, breakthrough pain in the night was remarkably severe and numerical rating scale was 9-10/10. Pregabalin as analgesic adjuvant was administrated from dose of 75mg/day to 300mg/day and the breakthrough pain in the night disappeared completely. The patient underwent the second course of 5-FU/CDDP therapy without the pain. In the present case, the combined therapy of medical treatment and radiation therapy provided complete relief of the neuropathic pain. We conclude that it is an option to select pregabalin as effective agent for neuropathic pain in medical treatment.
本文介绍了一名60多岁患有晚期食管癌的男性病例。在随访期间，该患者在接受第一疗程的5-氟尿嘧啶/顺铂治疗后，出现了从右肩胛骨到上臂的疼痛和麻木。磁共振成像（MRI）显示第一胸椎有骨转移，且存在淋巴结转移，经臂丛神经侵犯诊断为神经性疼痛。于是开始进行放射治疗，并使用氯诺昔康和羟考酮控释片进行药物治疗。然而，夜间爆发性疼痛非常严重，数字评分量表评分为9 - 10分（满分10分）。加用普瑞巴林作为镇痛辅助药物，剂量从75毫克/天增加到300毫克/天，夜间爆发性疼痛完全消失。患者在无痛的情况下接受了第二疗程的5-氟尿嘧啶/顺铂治疗。在本病例中，药物治疗和放射治疗的联合治疗使神经性疼痛得到了完全缓解。我们得出结论，选择普瑞巴林作为药物治疗中神经性疼痛的有效药物是一种选择。
