Department of Pharmacy Services, University of Michigan Health, Ann Arbor, MI, 48109, USA.
University of Michigan College of Pharmacy, Ann Arbor, MI, 48109, USA.
Drugs. 2023 Aug;83(12):1067-1076. doi: 10.1007/s40265-023-01906-4. Epub 2023 Jun 22.
Despite being an essential part of whole-person care, patients with cancer often experience complex and under-treated pain. Managing cancer-related pain in patients who are also pregnant compounds the challenge for adequate pain management, as studies have largely excluded this population. Therapy for pain management should be guided by the cause and mechanism of pain. The objective of this review is to provide clinicians with an understanding of pain experienced by pregnant patients with cancer and medications that may be used to help manage cancer-related pain. Nociceptive pain results from damage to somatic or visceral tissues that may be directly caused by cancer. This type of pain can be managed in pregnant patients using acetaminophen and/or nonsteroidal antiinflammatory drugs as first-line agents. In nociceptive pain not managed by non-opioid analgesics, buprenorphine is recommended for those requiring chronic opioids to help manage their pain. Neuropathic pain that results from damage to the peripheral or central nervous system may also be directly caused by cancer, particularly chemotherapy. In pregnant patients, duloxetine and gabapentin should be considered first. Venlafaxine, pregabalin, tricyclic antidepressants, and sodium channel blockers should be avoided, if possible. Nociplastic pain is not directly caused by cancer but may be caused by ongoing peripheral nociceptive input or a condition that predates the cancer diagnosis. Duloxetine and gabapentin are reasonable agents to consider for treatment of nociceptive pain in pregnant patients. Cyclobenzaprine may also be helpful for nociplastic pain.
尽管癌症患者的整体护理至关重要，但他们常常面临复杂且治疗不足的疼痛问题。对于同时怀孕的癌症患者，疼痛管理的挑战更加复杂，因为研究大多排除了这部分人群。疼痛管理的治疗方法应根据疼痛的原因和机制来指导。本综述的目的是为临床医生提供有关患有癌症的孕妇所经历的疼痛以及可能用于帮助管理癌症相关疼痛的药物的理解。伤害感受性疼痛是由躯体或内脏组织损伤引起的，这种损伤可能直接由癌症引起。对于怀孕患者，可以使用对乙酰氨基酚和/或非甾体抗炎药作为一线药物来管理这种类型的疼痛。对于非阿片类镇痛药无法控制的伤害感受性疼痛，建议对于需要长期使用阿片类药物来缓解疼痛的患者使用丁丙诺啡。由外周或中枢神经系统损伤引起的神经性疼痛也可能直接由癌症引起，特别是化疗。对于怀孕患者，应首先考虑使用度洛西汀和加巴喷丁。如果可能，应避免使用文拉法辛、普瑞巴林、三环类抗抑郁药和钠离子通道阻滞剂。伤害感受性疼痛不是由癌症直接引起的，但可能由持续的外周伤害感受输入或癌症诊断前的疾病引起。对于怀孕患者的伤害感受性疼痛，度洛西汀和加巴喷丁是合理的治疗药物。环苯扎林也可能对伤害感受性疼痛有帮助。
