Walsh T D
Department of Clinical Studies, St. Christopher's Hospice, 51 - 53 Lawrie Park Road, Sydenham, London SE26 6DZ, and Department of Clinical Pharmacology, Guy's Hospital, St. Thomas Street, London SEI 9RT Great Britain.
Pain. 1984 Jan;18(1):1-11. doi: 10.1016/0304-3959(84)90121-0.
Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.
在过去十年中，在专门致力于晚期癌症症状控制的特殊科室使用阿片类药物积累了丰富的临床经验。这与阿片类药物的临床药理学文献出现了重要矛盾，令人质疑其与慢性疼痛治疗的相关性。具体就吗啡而言，很明显：它口服时是一种非常有效的镇痛药，剂量必须个体化，通常无需胃肠外给药或使用奇特的镇痛“鸡尾酒”，而且只要根据其药理学特性合理使用吗啡，耐受性、依赖性和呼吸抑制很少会成为妨碍有效控制疼痛的常见或严重问题。如果考虑毫克效价的差异，海洛因是吗啡的合适替代物（特别是用于肌肉注射），但在镇痛效果或副作用方面并无优势。本文总结了圣克里斯托弗临终关怀院使用口服吗啡治疗癌症疼痛的临床经验、支持这种方法的临床研究数据，并对出现争议的领域进行了评论。
