Department of Supportive Care, Institut Curie, PSL Research University, Paris, France.
Pain Management Centre, Grenoble-Alpes University Hospital, Grenoble, France.
Support Care Cancer. 2019 Aug;27(8):3147-3157. doi: 10.1007/s00520-019-04830-0. Epub 2019 May 11.
Most cancer patients experience many pain episodes depending on disruptive elements, leading them to the emergency room. The objective of the article is to describe common pitfalls that need to be avoided, as well as opportunities to be seized for repositioning patients back on their care pathway.
Critical reflection based on literature analysis and clinical practice.
Most forms of cancer are now chronic, evolving diseases, and patients are treated with high-technology targeted therapies with iatrogenic effects. Moreover, the multimorphic nature of cancer-related pain requires dynamic, interdisciplinary assessments addressing its etiology, its pathophysiology, its dimensions (sensory-discriminatory, cognitive, emotional, and behavioral), and the patient's perception of it, in order to propose the most adapted therapies. However, for most patients, cancer pain remains underestimated, poorly assessed, and under-treated. In this context, the key steps in emergency cancer pain management are as follows: • Quick relief of uncontrolled cancer pain: after eliminating potential medical or surgical emergencies revealed by pain, a brief questioning will make the use of carefully titrated morphine in most situations possible. • Assessment and re-assessment of the pain and the patient, screening specific elements, to better understand the situation and its consequences. • Identification of disruptive elements leading to uncontrolled pain, with an interdisciplinary confrontation to find a mid to long-term approach, involving the appropriate pharmaceutical and/or non-pharmaceutical strategies, possibly including interventions.
Pain emergencies should be part of the cancer care pathway and, through supportive care, provide an opportunity to help cancer patients both maintain their physical, psychological, and social balance and anticipate further painful episodes.
大多数癌症患者会因各种干扰因素而经历多次疼痛发作，进而前往急诊室就诊。本文旨在描述常见的陷阱，并探讨重新定位患者回归其治疗路径的机会。
基于文献分析和临床实践的批判性反思。
目前，大多数癌症形式都是慢性、进展性疾病，患者接受的是具有医源性副作用的高科技靶向治疗。此外，癌症相关疼痛的多形态性质需要进行动态、跨学科的评估，以解决其病因、病理生理学、维度（感觉-辨别、认知、情感和行为）以及患者对疼痛的感知，从而提出最适合的治疗方法。然而，对于大多数患者来说，癌症疼痛仍然被低估、评估不足和治疗不足。在这种情况下，急诊癌症疼痛管理的关键步骤如下：
快速缓解未控制的癌症疼痛：在消除疼痛所揭示的潜在医疗或手术紧急情况后，通过简短的询问，在大多数情况下可以使用精心滴定的吗啡。
评估和重新评估疼痛和患者，筛选特定的因素，以更好地了解情况及其后果。
识别导致未控制疼痛的干扰因素，通过跨学科的对抗，寻找中期至长期的方法，包括适当的药物和/或非药物策略，可能包括干预措施。
疼痛紧急情况应成为癌症治疗路径的一部分，并通过支持性护理，为癌症患者提供维持身体、心理和社会平衡以及预测进一步疼痛发作的机会。
