Payne R
Department of Neurology, University of Cincinnati Medical Center, Ohio 45267.
Cancer. 1989 Jun 1;63(11 Suppl):2266-74. doi: 10.1002/1097-0142(19890601)63:11<2266::aid-cncr2820631135>3.0.co;2-5.
Cancer pain can be divided into three classes: somatic, visceral, and deafferentation. Somatic and visceral pain result from activation of nociceptors by tumor infiltration of tissues and from secondary inflammatory changes with release of algesic chemicals that act to sensitize nociceptors. Pain may be experienced locally (somatic and visceral) or referred to remote cutaneous sites (visceral). Deafferentation pain results from injury to the nervous system due to tumor infiltration or cancer therapy and may persist even after the cause of the injury has been removed. Somatic, visceral, and deafferentation pain may be complicated by sympathetically maintained pain, in which efferent sympathetic activity promotes persistent pain, hyperpathia, and vasomotor and sudomotor changes after tissue injury from cancer or its therapy. The neurobiology of cancer pain is complex and incompletely understood. This article summarizes current knowledge in this area and briefly discusses approaches to cancer pain management that are based on this knowledge.
躯体性疼痛、内脏性疼痛和去传入性疼痛。躯体性和内脏性疼痛是由于肿瘤浸润组织激活伤害感受器以及继发性炎症变化，释放出可使伤害感受器敏感化的致痛化学物质所致。疼痛可能在局部出现（躯体性和内脏性），也可能牵涉到远离的皮肤部位（内脏性）。去传入性疼痛是由于肿瘤浸润或癌症治疗导致神经系统损伤引起的，即使损伤原因已消除，疼痛仍可能持续。躯体性、内脏性和去传入性疼痛可能因交感神经维持性疼痛而变得复杂，在这种情况下，传出交感神经活动会促进组织因癌症或其治疗而受损后出现持续性疼痛、痛觉过敏以及血管舒缩和发汗变化。癌痛的神经生物学很复杂，尚未完全了解。本文总结了该领域的现有知识，并简要讨论了基于这些知识的癌痛管理方法。
