Hammack J E, Loprinzi C L
Department of Neurology, Mayo Clinic Rochester, Minnesota 55905.
Mayo Clin Proc. 1994 Apr;69(4):384-90. doi: 10.1016/s0025-6196(12)62226-5.
To summarize the important principles of opioid analgesia for cancer-related pain.
We reviewed our personal experience and reports in the literature to characterize commonly prescribed high-potency opioids and their relative efficacy.
The pharmacologic features of various opioids, selection of appropriate agents, titration of doses, routes of administration, conversions between drugs, and management of side effects are discussed.
In general, the oral route is preferred because of ease of administration and good oral bioavailability of most opioids. In addition to the scheduled dosage of an opioid, extra "rescue" doses (5 to 10% of the total daily opioid dosage) should be available to the patient for breakthrough pain. Morphine is the prototype strong opioid against which other drugs are compared. Common adverse effects of opioids are sedation, nausea, constipation, respiratory depression, and myoclonus. Although no "standard" dose of opioid exists, the goals are to achieve adequate control of pain and to avoid major, unmanageable toxic effects.
Pain is commonly associated with all stages of malignant disease. Despite its widespread occurrence, cancer pain is often inadequately managed because of poor assessment of pain and physicians' misconceptions about use of opioids. The cause of the pain should be carefully sought because it may yield important information about the underlying malignant disease. In most patients with moderate to severe cancer-related pain, oral administration of the appropriate opioid will achieve effective analgesia.
总结阿片类药物用于癌症相关疼痛镇痛的重要原则。
我们回顾了自身经验及文献报道，以描述常用的高效阿片类药物及其相对疗效。
讨论了各类阿片类药物的药理学特性、合适药物的选择、剂量滴定、给药途径、药物间转换以及副作用的处理。
一般而言，口服途径更佳，因为多数阿片类药物易于给药且口服生物利用度良好。除了按计划给药外，还应为患者准备额外的“解救”剂量（占每日阿片类药物总剂量的5%至10%）以应对爆发性疼痛。吗啡是用于对比其他药物的典型强效阿片类药物。阿片类药物常见的不良反应包括镇静、恶心、便秘、呼吸抑制和肌阵挛。尽管不存在阿片类药物的“标准”剂量，但目标是实现对疼痛的充分控制并避免严重的、难以处理的毒性作用。
疼痛常与恶性疾病的各个阶段相关。尽管癌症疼痛普遍存在，但由于疼痛评估不佳以及医生对阿片类药物使用的误解，其管理往往不足。应仔细寻找疼痛的原因，因为这可能提供有关潜在恶性疾病的重要信息。在大多数中重度癌症相关疼痛患者中，口服适当的阿片类药物可实现有效的镇痛。
