Bourhis A, Boudouresque G, Pellet W, Fondarai J, Ponzio J, Spitalier J M
Institut J. Paoli-I. Calmettes, 232, Bd de Sainte-Marguerite, 13273 Marseilles France.
Pain. 1978 Oct;5(3):263-274. doi: 10.1016/0304-3959(78)90013-1.
The treatment of cancer pain by psychotropic drugs is a method which has been employed for a long time [8] and in which the results obtained have appeared very interesting from the beginning: there is a high percentage of success, rapid action, absence of addiction, and although there are sometimes unpleasant side-effects, they are reversible when the treatment is stopped. Even after several years of application, this therapy still sets some unsolved problems. Some consider that psychotropics are not real analgesics, but that they work on the emotional reaction rather than on the pain itself [3]. Still others consider that the results are obtained only at the price of a state of prostration of the patient similar to that obtained after lobectomy. Finally, this procedure is reproached as having unpredictable results and indications difficult to define. We think that what has, up to now, prevented these types of problems from being solved has been the absence of a really objective evaluation of the pain in the patients observed. We have wrestled with this problem for several years [1,2], and offer the following hypothesis: what is important in considering chronic pain is, above all, the infirmity conferred upon the patient. If "pain" in the broad sense of the term lends itself to objective evaluation with difficulty, it is not the same with respect to infirmity. A method of evaluation of the physical disability intended for routine practice in a cancer center has been used on a series of 100 patients. The results obtained in this series have been analyzed and give the answer to questions such as mechanism of action, indications of psychotropic drugs and prognosis of cancer pain.
使用精神药物治疗癌症疼痛是一种已被采用很长时间的方法[8]，从一开始所获得的结果就显得非常有趣：成功率高、起效迅速、无成瘾性，而且尽管有时会有令人不适的副作用，但在治疗停止后这些副作用是可逆的。即使经过数年应用，这种疗法仍存在一些未解决的问题。一些人认为精神药物并非真正的镇痛药，而是作用于情绪反应而非疼痛本身[3]。还有一些人认为，取得的效果是以患者出现类似于肺叶切除术后的虚脱状态为代价的。最后，这种方法被指责结果不可预测且适应证难以界定。我们认为，迄今为止阻碍解决这类问题的原因是对所观察患者的疼痛缺乏真正客观的评估。我们已经围绕这个问题进行了数年的研究[1,2]，并提出以下假设：在考虑慢性疼痛时，最重要的首先是患者所遭受的虚弱状态。如果广义的“疼痛”难以进行客观评估，那么虚弱状态则并非如此。一种用于癌症中心常规实践的身体残疾评估方法已应用于一系列100例患者。对该系列所获得的结果进行了分析，并对诸如作用机制、精神药物的适应证以及癌症疼痛的预后等问题给出了答案。
