Tontschev G
Zentralinstitut für Krebsforschung der Akademie der Wissenschaften der DDR, Robert-Rössle-Institut, Berlin-Buch.
Arch Geschwulstforsch. 1989;59(1):53-63.
A comprehensive conception for cancer pain treatment is presented. The medical analgesic drug therapy representing the main point of this conception is applied as a three steps analgesic ladder as recommend by the WHO. This kind of therapy enables an individual adaptation resp. increase of the analgesic intensity by the use of non narcotic analgetics, weak and strong opioids as well as adjuvant drugs. Besides the explanation of the principles of its application and some detailed instructions for the dosage of several drugs, possible side effects and interactions are mentioned as well as some examples for its clinical application are quoted. A further increase of the analgesic intensity is reached by the local intraspinal application of morphine. For this purpose epidural and intrathecal long-term catheters are used. Also in these cases dosage, side effects and complications are mentioned and the possibilities and advantages of the continuous analgesia with implantable systems (pain ports) and external portable or implantable pumps are discussed. Furthermore the role of the neurolytic blocks, neurosurgical treatment and radiation therapy within this conception is mentioned.
本文提出了一种癌症疼痛治疗的综合理念。作为该理念核心的医学镇痛药物治疗，采用了世界卫生组织推荐的三阶梯镇痛法。这种治疗方法能够通过使用非麻醉性镇痛药、弱阿片类和强阿片类药物以及辅助药物，实现个体化调整或提高镇痛强度。除了解释其应用原则并给出几种药物剂量的详细说明外，还提到了可能的副作用和相互作用，并列举了一些临床应用实例。通过局部脊髓内应用吗啡可进一步提高镇痛强度。为此使用硬膜外和鞘内长期导管。在这些情况下同样提到了剂量、副作用和并发症，并讨论了使用可植入系统（镇痛泵）以及外部便携式或可植入泵进行持续镇痛的可能性和优势。此外，还提到了神经溶解阻滞、神经外科治疗和放射治疗在这一理念中的作用。
