Boland Elaine G, Ahmedzai Sam H
aQueen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Cottingham bThe Medical School, University of Sheffield, Sheffield, UK.
Curr Opin Support Palliat Care. 2017 Sep;11(3):181-190. doi: 10.1097/SPC.0000000000000292.
As people are living longer after a diagnosis and primary treatment for cancer, or indeed living with cancer as a chronic disease, new problems are emerging in this growing population of so-called 'survivors'. Persistent or chronic pain is one of the commonest complaints, arising from the tissue damage caused by the original neoplasm, consequences of surgery and other therapies, and - especially in older people - multimorbidity. This review explores some of the principle causes and mechanisms of this phenomenon and reviews the evidence for their management.
We review recent findings regarding persistent pain in adults after surgery, chemotherapy (including targeted biological therapies), hormone manipulation and radiation therapy; and osteonecrosis from corticosteroid treatment in children with cancer. Recent research has revealed some of the molecular, genetic, phenotypic and psychological factors that predispose some people to developing more persistent pain after cancer, and their long-term outcomes.
Although persistent pain in cancer patients surviving after primary treatment has been recognized for decades, only recently has research shown how this arises and some possible ways to intervene by prevention and interventions. New holistic models for management of persistent cancer-related pain are needed.
随着癌症患者在确诊及接受初始治疗后存活时间延长，或者实际上是作为慢性病与癌症共存，在这一不断增长的所谓“幸存者”群体中出现了新问题。持续性或慢性疼痛是最常见的主诉之一，其源于原发肿瘤造成的组织损伤、手术及其他治疗的后果，以及——尤其是在老年人中——多种疾病并存。本综述探讨了这一现象的一些主要原因和机制，并综述了其管理的证据。
我们综述了关于成人术后、化疗（包括靶向生物疗法）、激素治疗和放射治疗后持续性疼痛的最新发现；以及癌症患儿接受皮质类固醇治疗后的骨坏死。最近的研究揭示了一些分子、遗传、表型和心理因素，这些因素使一些人在患癌后更容易出现更持久的疼痛及其长期后果。
尽管癌症患者在初始治疗后存活时的持续性疼痛已被认识数十年，但直到最近研究才表明其产生方式以及一些通过预防和干预进行介入的可能方法。需要新的整体模型来管理持续性癌症相关疼痛。
