Meserve Jonathan R, Kaye Alan David, Prabhakar Amit, Urman Richard D
Combined Pediatrics and Anesthesia Residency, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA.
Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, USA.
Best Pract Res Clin Anaesthesiol. 2014 Jun;28(2):139-51. doi: 10.1016/j.bpa.2014.04.004. Epub 2014 May 22.
The treatment of cancer pain is paramount to both medical practitioner and patient in order to maximize quality of life. Cancer pain results from direct tumor effects as well as from surgical and medical treatments. Despite therapeutic advancements, morbidity and mortality in cancer care remains high, often from local recurrence or metastasis. Increasing evidence suggests analgesics affect the cellular milieu of malignant and nonmalignant cells and may influence cancer outcomes by directly stimulating tumor growth and inhibiting immune surveillance. Opioids have been shown to cause immunosuppression and stimulate malignant cells in vitro, though adjunct analgesics may additionally promote tumor cell growth. These results have led many to hypothesize that regional analgesic techniques may offer survival advantages to systemic analgesics. Thus far, the data do not support specific analgesic recommendations for the cancer patient, though ongoing prospective, randomized clinical trials are under way to better characterize the safest analgesic regimens for cancer patients.
为了最大限度地提高生活质量，癌症疼痛的治疗对医生和患者都至关重要。癌症疼痛源于肿瘤的直接影响以及手术和药物治疗。尽管治疗取得了进展，但癌症护理中的发病率和死亡率仍然很高，通常是由于局部复发或转移。越来越多的证据表明，镇痛药会影响恶性和非恶性细胞的细胞环境，并可能通过直接刺激肿瘤生长和抑制免疫监视来影响癌症的治疗结果。阿片类药物已被证明在体外会导致免疫抑制并刺激恶性细胞，尽管辅助镇痛药可能还会促进肿瘤细胞生长。这些结果使许多人推测，区域镇痛技术可能比全身镇痛药具有生存优势。到目前为止，数据并不支持针对癌症患者的特定镇痛建议，不过正在进行前瞻性随机临床试验，以更好地确定癌症患者最安全的镇痛方案。
