Kenner D J
Aust Fam Physician. 1994 Jul;23(7):1279-83.
Neuropathic pain is often a reason for an unfavourable response to morphine or other opioids in treating cancer pain. This type of pain is difficult to manage and may co-exist with nociceptive cancer pain. There is still a potential for opioid responsiveness, although the doses needed will be higher, and adjuvant drug therapies are best employed concurrently with opioid drugs. Adjuvant drugs used are the antidepressants, anticonvulsants, including benzodiazepines, corticosteroids and neurolepts. Less commonly, agents such as baclofen and clonidine, and sympatholytic drugs such as prazosin can be employed for sympathetically maintained neuropathic pain (discussed in Part 3). The type of agent selected will depend on the natural history of the disease process, as well as a description of the pain--the lancinating pains tending to respond better to anticonvulsants. Non invasive neurostimulatory approaches such as transcutaneous electrical nerve stimulation (TENS) may be useful in management, and a few patients may require an invasive procedure such as dorsal column stimulation.
神经性疼痛常常是癌症疼痛治疗中对吗啡或其他阿片类药物反应不佳的一个原因。这类疼痛难以处理，且可能与伤害感受性癌症疼痛同时存在。尽管所需剂量会更高，但阿片类药物仍有发挥作用的可能，辅助药物治疗最好与阿片类药物同时使用。使用的辅助药物有抗抑郁药、抗惊厥药（包括苯二氮䓬类）、皮质类固醇和抗精神病药。较少使用的药物如巴氯芬和可乐定，以及如哌唑嗪等抗交感神经药物可用于交感神经维持的神经性疼痛（在第3部分讨论）。所选药物的类型将取决于疾病进程的自然史以及疼痛的描述——刺痛性疼痛往往对抗惊厥药反应更好。非侵入性神经刺激方法如经皮电刺激神经疗法（TENS）在治疗中可能有用，少数患者可能需要如脊髓后柱刺激等侵入性手术。
