Twycross R G
Bull Cancer. 1980;67(2):209-16.
Careful assessment is a necessary preliminary to treatment; pain may be caused by a variety of mechanisms or associated with a non-malignant condition. In the majority of patients treatment should be planned on a multimodality basis. The fact that pain is a somato-psychic phenomenon must not be forgotten. Analgesics should be gives regularly, usually every four hours. Whereas the optimal dose of non-narcotic and weak narcotic drugs vary little the optimal dose for the stronger narcotic analgesics varies considerably. Aspirin or other non-steroidal anti-inflammatory drugs should always be used in metastatic bone pain, usually with a narcotic. Morphine sulphate in solution administered by mouth is the narcotic analgesic of choice in far-advanced cancer. When used as described, escalation of dose (tolerance) is not a practical problem. Physical dependence does not prevent the downward adjustment of dose should this become feasible as a result of non-drug intervention. Psychological dependence (addiction) does not occur if the patient is closely supervised and given adequate emotional support.
仔细评估是治疗的必要前提；疼痛可能由多种机制引起或与非恶性疾病相关。大多数患者的治疗应基于多模式进行规划。绝不能忘记疼痛是一种身心现象这一事实。镇痛药应定期给药，通常每四小时一次。虽然非麻醉性和弱麻醉性药物的最佳剂量变化不大，但较强麻醉性镇痛药的最佳剂量差异很大。阿司匹林或其他非甾体类抗炎药应始终用于转移性骨痛，通常与麻醉药合用。口服溶液剂型的硫酸吗啡是晚期癌症患者首选的麻醉性镇痛药。按所述使用时，剂量增加（耐受性）不是一个实际问题。如果由于非药物干预使得降低剂量可行，身体依赖性并不妨碍剂量的下调。如果对患者进行密切监测并给予充分的情感支持，就不会出现心理依赖性（成瘾）。
