Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
Drugs. 2017 Apr;77(6):629-635. doi: 10.1007/s40265-017-0710-8.
Patients with chronic pain often develop dysphagia during the course of an advanced disease such as cancer. Opioids are the cornerstone of the management of cancer pain and are commonly administered orally. However, the oral route does not suit patients with dysphagia, who require alternative methods to administer analgesic drugs. Opioids given by parenteral or transdermal routes provide adequate pain control, being at least as efficacious as the oral route, but knowledge and experience in conversion ratios are mandatory when using these routes of administration. For breakthrough pain, transmucosal fentanyl preparations should be the preferred option and these can be given as needed due to the route of absorption. In addition, a new class of opioid formulations has been developed for use in dysphagic patients that are administered via nasogastric or enteral tubes while maintaining their sustained-release properties.
患有慢性疼痛的患者在癌症等晚期疾病的病程中常常会出现吞咽困难。阿片类药物是治疗癌症疼痛的基石，通常口服给药。然而，口服途径并不适合吞咽困难的患者，他们需要替代方法来给予镇痛药物。通过肠外或透皮途径给予的阿片类药物可提供充分的疼痛控制，其疗效至少与口服途径相当，但在使用这些给药途径时，必须了解和掌握转换比。对于爆发性疼痛，透黏膜芬太尼制剂应作为首选，由于吸收途径的原因，可以按需给予。此外，还为吞咽困难患者开发了一类新的阿片类药物制剂，可通过鼻胃管或肠内管给药，同时保持其持续释放特性。
