Tang Jiying, Ding Feng, Yu Mincheng, Cai Xiaojun
Department of Oncology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.
Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
Medicine (Baltimore). 2025 May 16;104(20):e42433. doi: 10.1097/MD.0000000000042433.
Pain management in patients with malignant tumors and concomitant bone and soft tissue metastases remains a significant clinical challenge, with 10% to 20% experiencing refractory cancer pain. These patients often present with multiple comorbidities and abnormal biochemical markers, necessitating a multimodal approach to therapy. The personalized application of patient-controlled analgesia (PCA) technology has shown promise in enabling swift and effective pain management.
A 66 year old male patient with metastatic lower esophageal cardia cancer was hospitalized due to uncontrollable right chest and back pain. Effective control was achieved through multimodal comprehensive treatment, especially the application of PCA technology. At the same time, the patient also received the opportunity of antitumor therapy.
He was diagnosed with (1) stage IV cardial adenocarcinoma of lower esophagus (rT3N0M1); (2) secondary malignant tumor of bone; (3) refractory cancer pain (numerical rating scale score 6 scores); (4) chronic viral hepatitis B; (5) hepatic insufficiency; (6) incomplete intestinal obstruction; and (7) chronic erosive gastritis.
The complete process of cancer pain treatment for a patient with lower esophageal and cardia cancer was analyzed. The titration and rotation of opioid dosage, adjuvant treatment of underlying diseases, prevention and treatment of drug-related adverse reactions were introduced, with emphasis on PCA rapid titration.
The patient's cancer pain is well controlled, with mild adverse reactions and timely treatment. In addition, the patient also received antitumor treatment (radiotherapy and targeted therapy).
This case underscores the importance of comprehensive evaluation and precise diagnosis in cancer pain management, highlighting the need to address underlying conditions, conduct multidisciplinary consultations, and develop personalized analgesia plans. Such approaches can enhance pain treatment efficacy, minimize adverse reactions, and improve the overall quality of life for cancer patients.
恶性肿瘤合并骨与软组织转移患者的疼痛管理仍然是一项重大的临床挑战，10%至20%的患者会经历难治性癌痛。这些患者常伴有多种合并症和异常生化指标，需要采用多模式治疗方法。患者自控镇痛（PCA）技术的个性化应用在实现快速有效的疼痛管理方面已显示出前景。
一名66岁男性患者，因转移性下食管贲门癌导致右胸和背部疼痛无法控制而住院。通过多模式综合治疗，尤其是PCA技术的应用，实现了有效控制。同时，患者也获得了抗肿瘤治疗的机会。
他被诊断为（1）下食管贲门腺癌IV期（rT3N0M1）；（2）骨继发性恶性肿瘤；（3）难治性癌痛（数字评分量表评分为6分）；（4）慢性乙型病毒性肝炎；（5）肝功能不全；（6）不完全性肠梗阻；（7）慢性糜烂性胃炎。
分析了一名下食管和贲门癌患者癌痛治疗的全过程。介绍了阿片类药物剂量的滴定和轮换、基础疾病的辅助治疗、药物相关不良反应的预防和治疗，重点是PCA快速滴定。
患者的癌痛得到良好控制，不良反应轻微且治疗及时。此外，患者还接受了抗肿瘤治疗（放疗和靶向治疗）。
该病例强调了在癌痛管理中综合评估和精确诊断的重要性，突出了处理基础疾病、进行多学科会诊以及制定个性化镇痛计划的必要性。这些方法可以提高疼痛治疗效果，最大限度减少不良反应，并改善癌症患者的整体生活质量。
