Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi F
Cancer. 1987 Feb 15;59(4):850-6. doi: 10.1002/1097-0142(19870215)59:4<850::aid-cncr2820590432>3.0.co;2-1.
The method for cancer pain relief proposed by the World Health Organization (WHO) consists of guidelines for a three-step treatment, from non-opioids to weak and then strong opioids, according to need. Adjuvant drugs can be added to each step. This report presents the 2-year experience of the WHO Collaborating Centre at the National Cancer Institute of Milan in the use of this method. This retrospective study shows that a correct use of the analgesic ladder can reduce pain to a third of its initial intensity. The use of non-opioids had an average duration of 19.2 days; in 52% of the cases treatment was discontinued due to inefficacy and in 42%, to side effects. Weak opioids were administered on an average for 28.0 days. A shift to Strong opioids was made in 92% of the cases due to inefficacy and in 8% because of side effects. Treatment with strong opioids lasted for an average of 46.6 days and can be considered the mainstay of cancer pain therapy. Performance status was not altered considerably during the study and hours of sleep were doubled. The analgesic ladder proved efficacious in 71% of the cases. Neurolytic procedures had to be used in 29%. The authors conclude that analgesics, as proposed by WHO, are the most suitable treatment arm in controlling pain in palliative treatment for advanced cancer patients. Lack of availability or underuse of opioids constitute the real obstacle to the application of this method.
世界卫生组织（WHO）提出的癌症疼痛缓解方法包括三步治疗指南，即根据需要从非阿片类药物过渡到弱阿片类药物，再到强阿片类药物。每一步均可添加辅助药物。本报告介绍了米兰国立癌症研究所WHO合作中心使用该方法的两年经验。这项回顾性研究表明，正确使用止痛阶梯可将疼痛减轻至初始强度的三分之一。非阿片类药物的平均使用时长为19.2天；52%的病例因无效而停药，42%因副作用停药。弱阿片类药物的平均使用时长为28.0天。92%的病例因无效而改用强阿片类药物，8%因副作用改用。强阿片类药物的治疗平均持续46.6天，可被视为癌症疼痛治疗的主要手段。研究期间患者的身体状况没有明显改变，睡眠时间增加了一倍。止痛阶梯在71%的病例中证明有效。29%的病例必须采用神经溶解术。作者得出结论，WHO提议的镇痛药是晚期癌症患者姑息治疗中控制疼痛最合适的治疗手段。阿片类药物供应不足或使用不足是应用该方法的真正障碍。
