Ramanjulu Raghavendra, Thota Raghu S, Ahmed Arif, Jain Parmanand, Salins Naveen, Bhatnagar Sushma, Chatterjee Aparna, Bhattacharya Dipasri
Department of Pain and Palliative Care, Cytecare Hospital, Bengaluru, Karnataka, India.
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Palliat Care. 2020 Apr-Jun;26(2):173-179. doi: 10.4103/0973-1075.285692.
The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group guidelines on pharmacological management of cancer pain in adults provides a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub drafts addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website, and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that analgesics for cancer pain management should follow the World Health Organization three-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of first choice for moderate-to-severe cancer pain.
印度疼痛研究协会（ISSP）癌症疼痛特别兴趣小组关于成人癌症疼痛药物治疗的指南提供了一种结构化的、逐步推进的方法，这将有助于改善癌症疼痛的管理，并为患者提供最低可接受的生活质量。这些指南是根据现有文献和证据制定的，以适应印度的需求、患者群体和情况。一份基于每个子草案关键要素的问卷被发布在ISSP网站上，该问卷针对某些缺乏证据的不确定领域，并通过电子邮件分发给所有ISSP和印度姑息治疗协会（IAPC）成员。我们建议，用于癌症疼痛管理的镇痛药应遵循世界卫生组织针对疼痛严重程度的三步镇痛阶梯。对于轻至中度疼痛，应单独使用对乙酰氨基酚和非甾体抗炎药，或与阿片类药物联合使用。对于轻至中度疼痛，可将曲马多、他喷他多和可待因等弱阿片类药物与非阿片类镇痛药联合使用。我们推荐吗啡作为中至重度癌症疼痛的首选阿片类药物。
