Twycross R G
Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford, England.
Oncology (Williston Park). 1988 Apr;2(4):35-44, 47.
Pain is a complex somato-psychic experience, and all pains do not respond equally to opioid analgesics. Muscle and deafferentation pains are best eased by alternative treatments. Bone pain responds best to the combined use of morphine and an NSAID. Nerve compression often necessitates the concurrent use of a corticosteroid. Few patients need neurolytic or neuro-ablative procedures. Opioid use is governed by three key principles: "By the mouth," "by the clock," and "by the ladder." Morphine remains the strong opioid of choice for most patients. Respiratory depression is not a problem, nor is tolerance. Addiction (psychological dependence) does not occur in patients with opioid responsive pains.
疼痛是一种复杂的躯体 - 心理体验，并非所有疼痛对阿片类镇痛药的反应都相同。肌肉疼痛和传入神经阻滞性疼痛通过替代疗法能得到最佳缓解。骨痛对吗啡和非甾体抗炎药联合使用反应最佳。神经受压常常需要同时使用皮质类固醇。很少有患者需要神经溶解或神经毁损手术。阿片类药物的使用遵循三个关键原则：“口服”“按时”和“按阶梯”。吗啡仍是大多数患者首选的强效阿片类药物。呼吸抑制不是问题，耐受性也不是问题。对于阿片类药物敏感的疼痛患者不会出现成瘾（心理依赖）情况。
