McQuay H J, Jadad A R
Oxford Regional Pain Relief Unit, Nuffield Department of Anaesthetics, University of Oxford.
Cancer Surv. 1994;21:17-24.
Incident pain is a major problem for most patients with cancer pain. It is difficult to classify and poorly studied. The problem is that doses of opioids high enough to control episodic incident pain are too high when that pain is absent, leading to adverse effects. The commonest type of incident pain is pain on movement, leading to a quantitative increase in pain intensity. There is also a class of incident pain that is qualitatively different from any pain at rest, more akin to neuropathic pain. "Breakthrough" pain is the term used to describe pains that break through an existing analgesic regimen; these may be incident pains. There are no randomized controlled trials of incident pain management in cancer pain. The suggestions made for improving management are therefore based on such trials in other pain contexts. Studies in the cancer context will need to concentrate on characterizing the pain episodes.
突发性疼痛是大多数癌症疼痛患者面临的主要问题。它难以分类且研究较少。问题在于，当疼痛不存在时，足以控制突发性疼痛发作的阿片类药物剂量过高，会导致不良反应。最常见的突发性疼痛类型是运动时的疼痛，会导致疼痛强度在数量上增加。还有一类突发性疼痛在性质上与静息时的任何疼痛都不同，更类似于神经性疼痛。“爆发性”疼痛是用于描述突破现有镇痛方案的疼痛的术语；这些可能是突发性疼痛。目前尚无针对癌症疼痛中突发性疼痛管理的随机对照试验。因此，关于改善管理的建议是基于其他疼痛背景下的此类试验得出的。癌症背景下的研究需要集中于对疼痛发作进行特征描述。
