Cherny N I, Foley K M
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York 10021.
Ann Acad Med Singap. 1994 Mar;23(2):139-59.
Pain, which is among the most prevalent symptoms experienced by cancer patients, can be effectively treated. Patient assessment, the use of anticancer therapies and systemically administered non-opioid and opioid analgesics are pivotal. Practical aspects of opioid pharmacology include both drug selection, methods of analgesic administration: selection of the appropriate route, dose titration, and an understanding of the management of side effects. Specific approaches for the management of patients unable to attain an acceptable balance between relief and side effects of opioids are described. These comprise non-invasive interventions, including the use of adjuvant analgesics, psychological therapies and physiatric techniques, and invasive interventions, such as the use of intraspinal opioids, neural blockade and neuroablative techniques. Finally, the use of sedation in the management of patients with pain that is refractory to other interventions is addressed. This approach can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine to address these difficult problems.
疼痛是癌症患者最常见的症状之一，可得到有效治疗。患者评估、抗癌治疗的使用以及全身应用非阿片类和阿片类镇痛药至关重要。阿片类药物药理学的实际应用包括药物选择、镇痛给药方法：选择合适的给药途径、剂量滴定以及对副作用管理的理解。描述了针对无法在阿片类药物的缓解效果和副作用之间达到可接受平衡的患者的具体管理方法。这些方法包括非侵入性干预，如使用辅助镇痛药、心理治疗和物理治疗技术，以及侵入性干预，如使用脊髓内阿片类药物、神经阻滞和神经毁损技术。最后，讨论了在其他干预措施难以缓解疼痛的患者管理中使用镇静的问题。这种方法可为绝大多数患者提供充分缓解，其中大多数患者仅对全身药物治疗有反应。难治性疼痛患者应能够获得疼痛管理或姑息医学专家的帮助，以解决这些难题。
