Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, UK.
Br J Anaesth. 2013 Jul;111(1):105-11. doi: 10.1093/bja/aet208.
Cancer-related neuropathic pain is common; it can be disease related or related to the acute or chronic effects of cancer treatment. For example, chemotherapy-induced peripheral neuropathy occurs in 90% of patients receiving neurotoxic chemotherapy. Cancer treatments have become more effective; patients are living longer with cancer and there are more cancer survivors. However, side-effects (particularly neuropathy) have become more problematic. The key to management of cancer-related neuropathy is a considered assessment, remembering not to miss the opportunity of reversing the cause of the pain with appropriate oncological management. An increasing range of oncological therapies are available, including radiotherapy, chemotherapy, hormonal therapy, or one of the evolving approaches (e.g. immune therapies). Patients are often elderly and with comorbidities; therefore, all treatment decisions have to be made carefully and reviewed appropriately. Cancer pain is often of mixed aetiology or, if purely neuropathic, may be one of several pains experienced by a patient. For these reasons, opioids are used more frequently in patients with cancer-related neuropathic pain. Standard guidelines for the use of anticonvulsants (e.g. pregabalin and gabapentin), antidepressants (e.g. duloxetine and tricyclics), and topical treatments (e.g. capsaicin and lidocaine) may be applicable, but there is a lack of good-quality clinical trials in cancer-related neuropathic pain. Choice is dictated not just by age, drug interactions, and comorbidities, but also by the coexistence of many symptoms in patients with cancer. Treating more than one symptom with a particular neuropathic pain agent can avoid polypharmacy.
癌相关性神经病理性疼痛较为常见；其可由疾病本身引起，也可由癌症治疗的急性或慢性作用引起。例如，接受神经毒性化疗的患者中有 90% 会发生化疗引起的周围神经病。癌症治疗已变得更加有效；患者带瘤生存时间更长，且癌症幸存者人数更多。然而，副作用（尤其是神经病变）变得更加棘手。癌相关性神经病理性疼痛管理的关键在于进行全面评估，切记不要错过通过适当的肿瘤学管理来逆转疼痛病因的机会。可供选择的肿瘤学治疗方法越来越多，包括放疗、化疗、激素治疗，或一些新出现的方法（如免疫疗法）。患者通常为老年人且合并有多种疾病；因此，必须仔细做出所有治疗决策并进行适当的审查。癌症疼痛通常具有混合病因，或者如果为纯粹的神经病理性疼痛，则可能是患者经历的多种疼痛之一。由于这些原因，在伴有癌相关性神经病理性疼痛的患者中更频繁地使用阿片类药物。抗惊厥药（如普瑞巴林和加巴喷丁）、抗抑郁药（如度洛西汀和三环类抗抑郁药）和局部治疗（如辣椒素和利多卡因）的使用标准指南可能适用，但在癌相关性神经病理性疼痛中缺乏高质量的临床试验。选择不仅取决于年龄、药物相互作用和合并症，还取决于癌症患者存在的多种症状。用特定的神经病理性疼痛药物治疗多种症状可以避免使用多种药物。
