Hill C S
Department of Neuro-Oncology, University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston.
Semin Oncol. 1993 Apr;20(2 Suppl 1):1-5.
Despite widespread knowledge about many aspects of pain relief and the availability of appropriate opioid analgesics, inadequate pain management of cancer patients remains pervasive. The reasons can be classified into three categories: (1) societal barriers: (some health care providers still classify patients requiring "atypical" pain control as actual or potential drug abusers and continue to be affected by the deep-rooted negative image of opium and its misuse throughout history), (2) knowledge deficits (care givers often do not recognize the need for individualized treatment in accordance with the specific pain syndrome, the profile of the patient, the appropriate analgesic regimen, or the route of dosing; in addition, physical dependence, addiction, and tolerance are often regarded as synonymous and not clearly distinguished from one another), and (3) influence of governmental regulations (because drug regulatory guidelines concerning opioids are often vague and ambiguous, physicians are uncertain about what constitutes legitimate opioid use and fear regulatory and legal sanctions when prescribing opioid analgesics in higher than "normal" amounts; as a result, pain is often undertreated). It is imperative that we strive to overcome these barriers and correct societal biases and misinformation in order to create a more rational plan for effective cancer pain management in which opioid analgesics are utilized appropriately.
尽管人们对疼痛缓解的诸多方面已有广泛了解，且有合适的阿片类镇痛药可供使用，但癌症患者的疼痛管理不足现象仍然普遍存在。原因可分为三类：（1）社会障碍：（一些医疗保健提供者仍将需要“非典型”疼痛控制的患者归类为实际或潜在的药物滥用者，并且继续受到鸦片及其历史上滥用的根深蒂固的负面形象的影响），（2）知识缺陷（护理人员往往没有认识到需要根据特定的疼痛综合征、患者情况、适当的镇痛方案或给药途径进行个体化治疗；此外，身体依赖、成瘾和耐受性常常被视为同义词，且彼此之间没有明确区分），以及（3）政府法规的影响（由于有关阿片类药物的药品监管指南往往含糊不清，医生不确定什么构成合法使用阿片类药物，并且在开具高于“正常”剂量的阿片类镇痛药时担心受到监管和法律制裁；结果，疼痛常常得不到充分治疗）。我们必须努力克服这些障碍，纠正社会偏见和错误信息，以便制定一个更合理的有效癌症疼痛管理计划，在该计划中阿片类镇痛药能够得到适当使用。
