Hochberg Uri, Elgueta Maria Francisca, Perez Jordi
Cancer Pain Program, McGill University Health Centre , Montreal, QC , Canada.
Alan Edwards Pain Management Unit, McGill University Health Centre , Montreal, QC , Canada.
Front Oncol. 2017 Feb 14;7:17. doi: 10.3389/fonc.2017.00017. eCollection 2017.
Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.
肺癌是全球四大最常见癌症之一。全面的患者护理不仅包括遵循临床指南来控制疾病并在可能的情况下治愈疾病，还包括适当的症状控制。疼痛是肺癌患者最常见的症状之一；它可能源于胸部结构的局部侵犯或转移至骨骼、神经或其他可能引起疼痛的解剖结构的转移性疾病。疼痛也可能是手术、化疗或放疗等治疗方法的结果。癌症疼痛的传统医学管理包括开具足够剂量的阿片类药物和辅助药物，以控制症状而不引起严重的药物副作用。当适当的药物治疗无法提供满意的镇痛效果或引起限制副作用时，可以考虑采用介入性癌症疼痛技术。介入性疼痛管理致力于使用侵入性技术，如关节注射、神经阻滞和/或神经溶解、神经调节和骨水泥强化技术，以诊断和治疗对传统医学管理有抵抗性的疼痛综合征。介入方法的优点包括更好的镇痛效果，而不会出现与药物相关的副作用，并且有可能减少阿片类药物的使用，从而避免中枢性副作用。本综述将描述肺癌患者中经常出现的各种疼痛综合征以及可能适用于这些病例的介入技术。
