Patt R B, Ellison N M
University of Texas, M. D. Anderson Cancer Center, Houston, USA.
Oncology (Williston Park). 1998 Jul;12(7):1035-46; discussion 1049-52.
"Breakthrough pain" is a common clinical term that has not been conclusively defined or described. Breakthrough pain is a transitory flare of pain experienced when baseline pain has been reduced to a mild or moderate level. Breakthrough pain may be characterized by its relationship to a fixed around-the-clock (ATC) opioid dose, rapid onset and short duration, precipitating events, predictability, pathophysiology (with nociceptive pain being most easily controlled), and etiology. The only prospective study of breakthrough pain conducted to date found a 63% prevalence of breakthrough pain in cancer patients referred to a pain service. Although prevalence figures from other studies vary widely, partly due to the populations chosen, all of the studies verify that breakthrough pain is a serious problem in cancer patients. In fact, several studies have listed incident pain, a subset of breakthrough pain, as a predictor of poor response to analgesic therapy. Breakthrough pain is currently managed with oral or parenteral breakthrough pain medications given in addition to the ATC analgesic regimen. The ATC dosage may also be increased until limited by side effects. Newer agents with a more rapid onset of analgesia and shorter duration of effect may help in the management of breakthrough pain.
“爆发性疼痛”是一个常见的临床术语，但尚未得到最终定义或描述。爆发性疼痛是指在基线疼痛已减轻至轻度或中度水平时所经历的短暂疼痛发作。爆发性疼痛的特征可能与其与固定的全天候（ATC）阿片类药物剂量的关系、快速起效和持续时间短、诱发事件、可预测性、病理生理学（伤害性疼痛最易控制）以及病因有关。迄今为止进行的唯一一项关于爆发性疼痛的前瞻性研究发现，转至疼痛门诊的癌症患者中爆发性疼痛的患病率为63%。尽管其他研究的患病率数据差异很大，部分原因是所选人群不同，但所有研究均证实爆发性疼痛在癌症患者中是一个严重问题。事实上，多项研究已将突发性疼痛（爆发性疼痛的一个子集）列为镇痛治疗反应不佳的预测指标。目前，除了ATC镇痛方案外，还通过口服或胃肠外给予爆发性疼痛药物来处理爆发性疼痛。ATC剂量也可能增加，直至受到副作用限制。起效更快、作用持续时间更短的新型药物可能有助于爆发性疼痛的管理。
