Anaesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France.
Pain Management Unit, Hospital Saint-Louis, Paris, France.
Support Care Cancer. 2019 Aug;27(8):3095-3104. doi: 10.1007/s00520-019-04825-x. Epub 2019 May 11.
Numerous studies on cancer patients have shown that cancer pain still remains underestimated, poorly assessed, and under-treated. Pain relief should be considered as early as possible within personalized care and as an integral part of quality healthcare in many countries. Nevertheless, personalized care is still insufficiently taken into consideration, partly due to improper or incomplete assessment of cancer pain. The objective of this article is to propose a practical approach to this complex assessment, as the first step to improving patients' quality of life.
Critical reflection based on literature analysis and clinical practice.
Assessment of cancer pain means evaluating the pain intensity over time, the dimensions of pain (sensory-discriminative, cognitive, emotional, and behavioral), the pathophysiological nature of pain (neuropathic, nociceptive, and nociplastic), the etiology, and the patient's perception (diffuse, localized, global). Cancer patients may have simple or multiple forms of pain (mixed, overlapped, combined, and associated). Furthermore, with the use of new specific therapies, the symptomatology of pain is also changing, and certain cancers are becoming chronic. Thus, cancer pain is an archetype of multimorphic pain, and its dynamic assessments (regular and repeated) require a multimodal and targeted approach in order to offer personalized pain management. Multimodal pain treatment must be adapted to the elements that disrupt cancer pain, to the patient's cancer and to the specific treatments.
The dynamic assessments of pain demand the simplest, and the most complete possible procedure, to avoid feasibility problems or self-/hetero-assessment excesses that might lead to less precise and less reliable results. Multimodal and interdisciplinary approaches are being developed, making it possible to optimize cancer pain management.
大量针对癌症患者的研究表明，癌症疼痛仍然被低估、评估不足且治疗不充分。在个性化护理中，应尽早考虑缓解疼痛，并将其视为许多国家优质医疗保健的一个组成部分。然而，个性化护理仍未得到充分考虑，部分原因是对癌症疼痛的评估不当或不完整。本文旨在提出一种实用方法来评估这种复杂的疼痛，作为提高患者生活质量的第一步。
基于文献分析和临床实践的批判性思考。
癌症疼痛评估意味着评估随时间推移的疼痛强度、疼痛的维度（感觉-辨别、认知、情感和行为）、疼痛的病理生理性质（神经病理性、伤害感受性和躯体感觉性）、病因和患者的感知（弥漫性、局限性、全身性）。癌症患者可能有简单或多种形式的疼痛（混合、重叠、合并和相关）。此外，随着新的特定疗法的使用，疼痛的症状也在发生变化，某些癌症也变成了慢性疾病。因此，癌症疼痛是多态性疼痛的典型范例，其动态评估（定期和重复）需要采用多模式和有针对性的方法，以提供个性化的疼痛管理。多模式疼痛治疗必须针对干扰癌症疼痛的因素、患者的癌症和特定的治疗方法进行调整。
疼痛的动态评估需要尽可能简单和完整的程序，以避免可行性问题或自我/他评过度，这可能导致结果不够精确和可靠。正在开发多模式和跨学科方法，以优化癌症疼痛管理。
