Cuhls H, Radbruch L, Brunsch-Radbruch A, Schmidt-Wolf G, Rolke R
Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn.
Internist (Berl). 2013 Feb;54(2):254, 256-62. doi: 10.1007/s00108-012-3230-3.
Palliative care patients do not only suffer from cancer pain but also from painful muscle spasticity due to multiple sclerosis, amyotrophic lateral sclerosis, after stroke or due to dementia if damage of the pyramidal motor system is present. Centrally active muscle relaxants can be helpful also when used as coanalgesics for cancer pain. In addition to opioids other coanalgesics, such as tricyclic antidepressants or serotonin/noradrenalin reuptake inhibitors as well as anticonvulsants (sodium channel and calcium channel blockers) can be helpful if neuropathic cancer pain is present. Idiopathic Parkinsonism or multiple system atrophy leads more to a painful rigor and pain control should be supported here by optimal adjustment of L-DOPA or DOPA agonist therapy. However, pain treatment should always address the psychological, social and spiritual demands of the patient.
姑息治疗患者不仅遭受癌症疼痛，还会因多发性硬化症、肌萎缩侧索硬化症、中风后或存在锥体运动系统损伤时因痴呆症而出现疼痛性肌肉痉挛。中枢性肌肉松弛剂作为癌症疼痛的辅助镇痛药使用时也可能有帮助。除了阿片类药物外，如果存在神经性癌症疼痛，其他辅助镇痛药，如三环类抗抑郁药或5-羟色胺/去甲肾上腺素再摄取抑制剂以及抗惊厥药（钠通道和钙通道阻滞剂）可能会有帮助。特发性帕金森病或多系统萎缩更多地导致疼痛性强直，在此应通过优化左旋多巴或多巴激动剂治疗来辅助疼痛控制。然而，疼痛治疗应始终关注患者的心理、社会和精神需求。
