Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
J Natl Compr Canc Netw. 2013 Mar;11 Suppl 1:S29-36. doi: 10.6004/jnccn.2013.0211.
The moral imperative to adequately manage pain is being increasingly recognized worldwide. A comprehensive pain management approach that addresses the various presentations of pain in patients with cancer is required, including appropriate management of breakthrough pain. Breakthrough pain commonly occurs in patients with advanced cancer and is disabling to the individual and burdensome to society, yet it is often inadequately managed. Because pain is heterogeneous, the best management of an individual's pain, including breakthrough pain in cancer, requires a thorough assessment to tailor the treatment strategies. Recently developed guidelines support this approach and recommend treating breakthrough pain using rapid- or short-acting opioids with pharmacodynamics that mirror the rapid onset and short duration of the presenting pain. This approach should be part of a comprehensive strategy to treat pain within the context of the primary disease trajectory, offering continuity of care and access to specialized palliative care when appropriate.
在全球范围内，人们越来越认识到充分管理疼痛的道德必要性。需要采取一种全面的疼痛管理方法来应对癌症患者的各种疼痛表现，包括适当管理爆发性疼痛。爆发性疼痛在晚期癌症患者中很常见，会使个体丧失能力，并给社会带来负担，但往往得不到充分的管理。由于疼痛具有异质性，因此，要对个体的疼痛进行最佳管理，包括对癌症患者的爆发性疼痛进行管理，需要进行彻底评估，以定制治疗策略。最近制定的指南支持这种方法，并建议使用药效学与疼痛呈现的快速发作和短暂持续时间相匹配的快速或短效阿片类药物来治疗爆发性疼痛。这种方法应该是在原发性疾病轨迹背景下治疗疼痛的综合策略的一部分，提供连续性护理，并在适当情况下提供专门的姑息治疗。
