Smith Thomas J, Saiki Catherine B
Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD.
Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medical Institutions, Baltimore, MD.
Mayo Clin Proc. 2015 Oct;90(10):1428-39. doi: 10.1016/j.mayocp.2015.08.009.
Safe, effective, and evidence-based management of cancer-related pain is a cornerstone of comprehensive cancer care. Despite increasing interest in and efforts to improve its management, pain remains poorly controlled in nearly half of all patients with cancer, with little change in the past 20 years. Limited training in pain assessment and management, overestimation of providers' own skills to treat pain, and failure to refer patients to pain specialists can result in suboptimal pain management with devastating effects on quality of life, physical functioning, and increased psychological distress. From a thorough assessment of cancer-related pain to appropriate treatments that may include opiates, adjuvant medications, nerve blocks, and nondrug interventions, this article is intended as a brief overview of the mechanisms and types of pain as well as a review of current, new, and promising approaches to its management.
癌症相关疼痛的安全、有效且基于证据的管理是综合癌症护理的基石。尽管人们对其管理的兴趣日益增加并付出了努力,但在近一半的癌症患者中,疼痛仍控制不佳,在过去20年里几乎没有变化。疼痛评估和管理方面的培训有限、对医疗服务提供者自身治疗疼痛技能的高估以及未能将患者转诊至疼痛专科医生,都可能导致疼痛管理不理想,对生活质量、身体功能产生毁灭性影响,并增加心理困扰。从对癌症相关疼痛的全面评估到可能包括阿片类药物、辅助药物、神经阻滞和非药物干预在内的适当治疗,本文旨在简要概述疼痛的机制和类型,以及对其当前、新的和有前景的管理方法进行综述。