Wirz S, Schenk M, Kleinmann B, Kieseritzky K
Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, CURA - Katholisches Krankenhaus im Siebengebirge, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.
Abteilung für Anästhesie und Schmerztherapie, Gemeinschaftskrankenhaus Havelhöhe, Krankenhaus für Anthroposophische Medizin, Berlin, Deutschland.
Schmerz. 2016 Dec;30(6):510-518. doi: 10.1007/s00482-016-0168-8.
Due to advances in oncological therapy options and increasing survival rates, the number of cancer patients with persistant pain, who are in need of analgesic therapy has increased. It has been proven that biopsychosocial mechanisms exist in patients with persistant non-cancer pain leading to chronification. Furthermore, addiction has been identified as a complication of analgesic therapy.
Can the multidimensional model of chronic pain enhancement and chronification be used for patients with cancer pain, analogue to patients with non-cancer pain? Can addiction sydromes as a result of analgesic treatment be demonstrated?
In this non-systematic review, a literature search was carried out for somatic and psychosocial chronification mechanisms in patients with cancer pain. Indications for potential addiction syndromes in cancer patients are demonstrated based on selected publications. A Medline search provided a number of relevant publications that are listed (see Supplementary Material).
Somatic chronification mechanisms, such as pain intensity, repetitive algesic stimuli, topical and demographic factors, are found both in persistant non-cancer pain and cancer pain. Cancer-induced peripheral and central sensitization mechanisms that can be due to underlying genetic variations, are specific for cancer pain. With regard to psychosocial determinants for pain chronification, both cancer and non-cancer patients show similar patterns. Furthermore, data from the literature support the existence of addiction in cancer patients.
In order to optimize treatment more attention should be paid to the risk of chronification and addiction in cases of chronic persistant cancer pain.
由于肿瘤治疗方案的进步以及生存率的提高，需要镇痛治疗的持续性疼痛癌症患者数量有所增加。已证实，持续性非癌性疼痛患者存在生物心理社会机制，可导致疼痛慢性化。此外，成瘾已被确认为镇痛治疗的一种并发症。
慢性疼痛加剧和慢性化的多维模型能否像用于非癌性疼痛患者一样用于癌症疼痛患者？能否证实镇痛治疗导致的成瘾综合征？
在这项非系统性综述中，检索了关于癌症疼痛患者躯体和心理社会慢性化机制的文献。基于所选出版物展示了癌症患者潜在成瘾综合征的指征。通过医学文献数据库检索获得了一些相关出版物并列出（见补充材料）。
在持续性非癌性疼痛和癌症疼痛中均发现了躯体慢性化机制，如疼痛强度、重复性痛觉刺激、局部和人口统计学因素。癌症诱导的外周和中枢敏化机制可能归因于潜在的基因变异，是癌症疼痛所特有的。关于疼痛慢性化的社会心理决定因素，癌症患者和非癌症患者表现出相似模式。此外，文献数据支持癌症患者存在成瘾现象。
为了优化治疗，对于慢性持续性癌症疼痛病例，应更加关注慢性化和成瘾风险。
