Dept of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg (UDS), EA 7293/Federation of Translational Medicine, Strasbourg, France.
Eur Respir J. 2017 Sep 10;50(3). doi: 10.1183/13993003.00611-2017. Print 2017 Sep.
This review of pain management in lung cancer is based on the presentation of four cases of thoracic oncology patients with pain at various stages of their disease. The approach will be multidisciplinary, involving a thoracic oncologist, radiologist, thoracic and orthopaedic spine surgeon, radiation therapist, pain medicine specialist, and palliative care specialist. This multispecialty approach to the management of different painful presentations in thoracic oncology will demonstrate the complexity of each case and the improved patient outcomes which result from the involvement of different disciplines working in concert.In the USA, Europe and other countries, palliative care specialists often become rapidly involved in the management of these patients, coordinating social care and providing psychological support.Thoracic and orthopaedic spine subspecialists provide surgical methods to control tumour invasion, and improve quality of life and preservation of function in settings of even diffuse metastatic disease. Similarly, thoracic oncology and radiation therapists utilise both therapeutic and palliative chemotherapeutic and radiation therapy regimens to prolong and improve quality of life.The pain medicine specialist can, in addition to medication management, offer a variety of interventional approaches including unique drug delivery systems such as epidural analgesia, regional anaesthesia techniques, and intrathecal pumps, as well as neuromodulation techniques and neurolytic or neuroablative procedures.In the USA, these specialists complete an additional fellowship year in pain medicine following the completion of an anaesthesiology, physical medicine and rehabilitation, neurology or psychiatry residency. These programmes are accredited by the Accreditation Council for Graduate Medical Education, or ACGME (www.acgme.org).
这篇关于肺癌疼痛管理的综述基于 4 例胸肿瘤科患者在疾病不同阶段的疼痛病例呈现。方法将是多学科的，涉及胸肿瘤科医生、放射科医生、胸科和骨科脊柱外科医生、放射治疗师、疼痛医学专家和姑息治疗专家。这种多学科方法治疗胸肿瘤科的不同疼痛表现将展示每个病例的复杂性以及来自不同学科协同工作的参与所带来的患者预后改善。在美国、欧洲和其他国家，姑息治疗专家通常会迅速参与这些患者的管理，协调社会护理并提供心理支持。胸科和骨科脊柱亚专科提供手术方法来控制肿瘤侵袭，并在即使是弥漫性转移疾病的情况下改善生活质量和保留功能。同样，胸肿瘤科和放射治疗师利用治疗和姑息性化疗和放射治疗方案来延长和改善生活质量。疼痛医学专家除了药物管理外，还可以提供多种介入方法，包括独特的药物输送系统，如硬膜外镇痛、区域麻醉技术和鞘内泵，以及神经调节技术和神经溶解或神经消融手术。在美国，这些专家在完成麻醉学、物理医学与康复、神经病学或精神病学住院医师培训后，还需要在疼痛医学领域完成额外的一年 fellowship。这些项目由研究生医学教育认证委员会 (Accreditation Council for Graduate Medical Education，ACGME) 认证，网址为：www.acgme.org。
