Talmi Y P, Waller A, Bercovici M, Horowitz Z, Pfeffer M R, Adunski A, Kronenberg J
Department of Otolaryngology-Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel.
Cancer. 1997 Sep 15;80(6):1117-23.
Pain is one of the most feared consequences of cancer and is experienced by up to 80% of patients with head and neck carcinoma (HNC). Pain in terminal HNC patients is common and often defined as severe. This study evaluated the effectiveness of the World Health Organization (WHO) analgesic ladder in the treatment of a cohort of terminal HNC patients.
The authors prospectively evaluated 62 consecutive terminal HNC patients admitted to the Chaim Sheba Medical Center Tel Hashomer Hospice or the general hospital. Data pertaining to tumor origin, spread, treatment, and results were defined. Pain was assessed with the McGill Pain Questionnaire, using a 10-point visual analogue scale (VAS) and a body map. Pain was diagnosed according to cause and type. Treatment was selected according to the guidelines provided in the WHO analgesic ladder.
Only 10 patients suffered from pain that was not locoregional. The results of the VAS score were available in the first reading in all patients with pain (n = 48), with a mean of 4.7 (standard deviation [SD] +/- 2.0). A mean second VAS score obtained 72 hours after the first was 1.9 (SD +/- 1.1). The difference between the two scores was statistically significant (P < 0.001). A third score was available for only 6 patients, with a mean of 1.6. Only 2 patients did not experience improvement of pain after 72 hours of treatment; both of these patients had bony involvement with tumor. Thirty-one patients (65%) were diagnosed with pain of nociceptive origin; these patients were categorized as having actual nociceptive pain (22), nociceptive nerve pain (6), or referred pain to the ear (3). Nonnociceptive pain of neuropathic origin was noted for only 6 patients (12.5%). Pain that could not be well defined but was responsive to opioid analgesic treatment was noted for 11 patients. A different form of non-cancer-related pain was noted for only one patient.
Patients were treated for pain according to the WHO analgesic ladder. They received adequate narcotic analgesics and supportive measures that allowed significant reduction of pain in nearly all cases, with acceptable side effects.
疼痛是癌症最令人恐惧的后果之一，高达80%的头颈癌（HNC）患者会经历疼痛。晚期HNC患者的疼痛很常见，且通常被定义为严重疼痛。本研究评估了世界卫生组织（WHO）镇痛阶梯在一组晚期HNC患者治疗中的有效性。
作者前瞻性地评估了62例连续入住海姆·谢巴医疗中心泰尔哈绍梅尔临终关怀医院或综合医院的晚期HNC患者。确定了与肿瘤起源、扩散、治疗及结果相关的数据。使用10分视觉模拟量表（VAS）和人体图，通过麦吉尔疼痛问卷评估疼痛。根据疼痛原因和类型进行诊断。根据WHO镇痛阶梯提供的指南选择治疗方法。
只有10例患者的疼痛并非局部性疼痛。所有疼痛患者（n = 48）首次读数时的VAS评分结果均可用，平均分为4.7（标准差[SD]±2.0）。首次读数72小时后获得的第二次VAS平均评分为1.9（SD±1.1）。两次评分之间的差异具有统计学意义（P < 0.001）。只有6例患者有第三次评分，平均分为1.6。只有2例患者在治疗72小时后疼痛未改善；这两名患者均有肿瘤累及骨质。31例患者（65%）被诊断为伤害性起源疼痛；这些患者被分类为实际伤害性疼痛（22例）、伤害性神经痛（6例）或耳部牵涉痛（3例）。仅6例患者（12.5%）出现神经性起源的非伤害性疼痛。11例患者出现无法明确界定但对阿片类镇痛药治疗有反应的疼痛。仅1例患者出现另一种与癌症无关的疼痛形式。
患者按照WHO镇痛阶梯接受疼痛治疗。他们接受了适当的麻醉性镇痛药和支持性措施，几乎在所有病例中都能显著减轻疼痛，且副作用可接受。
