Oncology and Palliative Care Units, Civil Hospital Carpi, USL, 41012 Carpi, Italy.
Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.
Int J Environ Res Public Health. 2020 Sep 28;17(19):7097. doi: 10.3390/ijerph17197097.
The increased recognition of the high prevalence and important burden of cancer pain and the documentation of a large proportion of patients receiving inadequate analgesic treatment should have reinforced the need for evidence-based recommendations. The World health Organization (WHO) guidelines on cancer pain management-or palliative care-are traditionally based on a sequential, three-step, analgesic ladder according to pain intensity: nonopioids (paracetamol or nonsteroidal anti-inflammatory drugs) to mild pain in step I; weak opioids (eg, codeine or tramadol) to mild-moderate pain in step II; and strong opioids to moderate-severe pain in step. III. Despite the widespread use of this ladder, unrelieved pain continues to be a substantial concern in one third of patients with either solid or hematologic malignancies. The sequential WHO analgesic ladder, and in particular, the usefulness of step II opioids have been questioned but there are no universally used guidelines for the treatment of pain in patients with advanced cancer and not all guideline recommendations are evidence-based. The American Society of Clinical Oncology and the European Society of Medical Oncology have recommended the implementation of early palliative care (EPC), which is a novel model of care, consisting of delivering dedicated palliative service concurrent with active treatment as early as possible in the cancer disease trajectory. Improvement in cancer pain management is one of the several important positive effects following EPC interventions. Independent well-designed research studies on pharmacological interventions on cancer pain, especially in the EPC setting are warranted and may contribute to spur research initiatives to investigate the poorly addressed issues of pain management in non cancer patients.
癌症疼痛的高患病率和重要负担日益受到认识，有大量患者接受的镇痛治疗不足的情况也有记录，这些都应该强化对基于证据的建议的需求。世界卫生组织（WHO）的癌症疼痛管理或姑息治疗指南传统上是基于按疼痛强度划分的、连续的三步镇痛阶梯：第 I 步用非阿片类药物（扑热息痛或非甾体抗炎药）治疗轻度疼痛；第 II 步用弱阿片类药物（如可待因或曲马多）治疗轻至中度疼痛；第 III 步用强阿片类药物治疗中至重度疼痛。尽管广泛使用这种阶梯，但仍有三分之一的实体瘤或血液恶性肿瘤患者存在未缓解的疼痛，这仍是一个重大问题。连续的 WHO 镇痛阶梯，特别是第二步阿片类药物的作用，一直受到质疑，但对于晚期癌症患者的疼痛治疗，没有普遍使用的指南，而且并非所有指南建议都基于证据。美国临床肿瘤学会和欧洲肿瘤内科学会都建议实施早期姑息治疗（EPC），这是一种新的护理模式，包括在癌症病程中尽早提供专门的姑息治疗服务，同时进行积极治疗。改善癌症疼痛管理是 EPC 干预的几个重要积极影响之一。有必要进行关于癌症疼痛药物干预的独立、精心设计的研究，特别是在 EPC 环境下，这可能有助于推动研究计划，以调查非癌症患者疼痛管理中未得到充分解决的问题。
