Psychosocial and Palliative Care Program (BS) and the Anesthesiology Program (JES) at the H. Lee Moffi tt Cancer Center and Research Institute, Tampa, Florida, USA.
Cancer Control. 2012 Apr;19(2):154-66. doi: 10.1177/107327481201900210.
Metastatic bone disease is a common cause of pain in cancer patients. A multidisciplinary approach to treatment is often necessary because simplified analgesic regimens may fail in the face of complex pain generators, especially those involved in the genesis of neuropathic pain. From the origins of formalized guidelines by the World Health Organization (WHO) to recent developments in implantable therapies, great strides have been made to meet the needs of these patients.
The authors review the existing literature on the pathophysiology and treatment options for pain generated by metastatic bone disease and summarize classic and new approaches.
Relatively recent animal models of malignant bone disease have allowed a better understanding of the intimate mechanisms involved in the genesis of pain, resulting in a mechanistic approach to its treatment. Analgesic strategies can be developed with specific targets in mind to complement the classic, opioid-centered WHO analgesic ladder obtaining improved outcomes and quality of life. Unfortunately, high-quality evidence is difficult to produce in pain medicine, and these concepts are evolving slowly.
Treatment options are expanding for the challenging clinical problem of painful metastatic bone disease. Efforts are concentrated on developing alternative nonopioid approaches that appear to increase the success rate and improve patients' quality of life.
转移性骨病是癌症患者疼痛的常见原因。由于简化的镇痛方案在面对复杂的疼痛产生源时可能会失败，特别是那些涉及神经性疼痛产生的情况，因此通常需要采用多学科方法进行治疗。从世界卫生组织（WHO）制定正式指南的起源到最近植入疗法的发展，已经取得了很大的进展，以满足这些患者的需求。
作者回顾了关于转移性骨病引起的疼痛的病理生理学和治疗选择的现有文献，并总结了经典和新方法。
最近的恶性骨病动物模型使人们对疼痛产生的内在机制有了更好的理解，从而为其治疗提供了一种基于机制的方法。可以针对特定目标制定镇痛策略，以补充经典的以阿片类药物为中心的 WHO 镇痛阶梯，从而获得更好的疗效和生活质量。不幸的是，在疼痛医学中很难产生高质量的证据，这些概念的发展较为缓慢。
针对转移性骨痛这一具有挑战性的临床问题，治疗选择正在不断扩大。目前的研究重点是开发替代非阿片类药物的方法，这些方法似乎可以提高成功率并改善患者的生活质量。
