Lamer T J
Department of Anesthesiology, Mayo Clinic Jacksonville, FL 32224.
Mayo Clin Proc. 1994 May;69(5):473-80. doi: 10.1016/s0025-6196(12)61647-4.
To summarize the available pain-relieving interventions other than oral medications for cancer-related pain.
The pertinent literature is reviewed, and the various options for treating pain in patients with cancer are discussed.
The appropriate situations for use of parenteral administration of opioids, spinal analgesia, neural blockade, and neurosurgical treatment are outlined, and the potential problems and complications associated with these techniques are described.
The basic approach to the management of pain in patients with cancer is to begin treatment with less potent analgesic agents early and to progress toward use of more potent pharmaceutical agents, adjuvant drugs, and invasive procedures as needed for alleviation of pain. With parenteral administration of opioids, the dosage can be adjusted rapidly, and therapy can be continued even though a patient may have gastrointestinal dysfunction. A portable ambulatory infusion pump can be used in selected patients. The major advantage of spinal opioid analgesia is the intense analgesia provided with minimal side effects. The potential complications and the availability of treatment alternatives have limited the use of neurolytic blocks, which usually provide only temporary relief of pain. In carefully selected patients with pancreatic or other upper gastrointestinal neoplasms, however, neurolytic celiac plexus and splanchnic nerve blocks are effective. Patients who fail to respond to conservative interventions may be candidates for neurosurgical procedures, such as spinal cord, cortical, or brain-stem stimulation or neuroablative operations (most commonly, cordotomy).
Cancer-related pain continues to be a major problem, and clinicians should be aware of the availability of effective treatment strategies and techniques. When orally administered medications fail to control pain or cause excessive side effects, patients should be referred to an appropriate specialist or medical center for consideration of other pain-relieving techniques.
总结除口服药物外用于癌症相关疼痛的可用止痛干预措施。
回顾相关文献，讨论癌症患者疼痛治疗的各种选择。
概述胃肠外给予阿片类药物、脊髓镇痛、神经阻滞和神经外科治疗的适用情况，并描述与这些技术相关的潜在问题和并发症。
癌症患者疼痛管理的基本方法是早期先用效力较弱的镇痛药开始治疗，并根据缓解疼痛的需要逐步使用效力更强的药物、辅助药物和侵入性操作。胃肠外给予阿片类药物时，剂量可迅速调整，即使患者可能有胃肠功能障碍也可继续治疗。可在选定患者中使用便携式门诊输液泵。脊髓阿片类镇痛的主要优点是镇痛效果强且副作用小。潜在并发症和其他治疗选择的可用性限制了神经溶解阻滞的应用，其通常只能暂时缓解疼痛。然而，在精心挑选的患有胰腺或其他上消化道肿瘤的患者中，神经溶解腹腔丛和内脏神经阻滞是有效的。对保守干预无反应的患者可能适合神经外科手术，如脊髓、皮质或脑干刺激或神经毁损手术（最常见的是脊髓切断术）。
癌症相关疼痛仍然是一个主要问题，临床医生应了解有效治疗策略和技术的可用性。当口服药物无法控制疼痛或引起过多副作用时，应将患者转诊至合适的专科医生或医疗中心，考虑其他止痛技术。
