Breitbart W
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Psychooncology. 1998 Jul-Aug;7(4):333-45. doi: 10.1002/(SICI)1099-1611(199807/08)7:4<333::AID-PON365>3.0.CO;2-F.
The 'WHO Analgesic Ladder' is a well validated approach for the selection of appropriate analgesic therapy for cancer pain as well as pain in AIDS. The mainstay of analgesic intervention for cancer and AIDS pain of moderate to severe intensity continues to be the appropriate use of opioid analgesics. There is, however, a growing appreciation for the role of adjuvant analgesics, such as antidepressants and other psychotropic medications, at each step of the WHO Analgesic Ladder, particularly in the treatment of neuropathic pain. Knowledge of the indications and usefulness of psychotropic analgesic drugs in cancer and AIDS pain populations will be most important to clinicians practicing in psycho-oncology/AIDS settings, particularly since these drugs are useful not only in the treatment of psychiatric complications of cancer and AIDS, but also as adjuvant analgesic agents in the management of pain. This paper reviews the literature on the use of antidepressants, psychostimulants, neuroleptics, anticonvulsants and other psychotropic analgesics in the management of cancer and AIDS pain. Mechanisms of analgesia, drug selection, and recommendations for clinical usage are discussed. The appropriate and timely use of psychotropic adjuvant analgesic drugs represents an opportunity for active psychiatric contribution to the multidisciplinary management of cancer and AIDS pain.
“世界卫生组织镇痛阶梯”是一种经过充分验证的方法，用于为癌症疼痛以及艾滋病相关疼痛选择合适的镇痛治疗。对于中度至重度的癌症和艾滋病疼痛，镇痛干预的主要手段仍然是合理使用阿片类镇痛药。然而，人们越来越认识到辅助镇痛药的作用，如抗抑郁药和其他精神药物，在世卫组织镇痛阶梯的每一步中都发挥着作用，特别是在治疗神经性疼痛方面。了解精神类镇痛药物在癌症和艾滋病疼痛人群中的适应症和效用，对于在心理肿瘤学/艾滋病领域执业的临床医生来说至关重要，尤其是因为这些药物不仅对治疗癌症和艾滋病的精神并发症有用，而且在疼痛管理中作为辅助镇痛药也很有用。本文综述了关于抗抑郁药、精神兴奋剂、抗精神病药、抗惊厥药和其他精神类镇痛药在癌症和艾滋病疼痛管理中应用的文献。讨论了镇痛机制、药物选择和临床使用建议。合理及时地使用精神类辅助镇痛药物为精神科积极参与癌症和艾滋病疼痛的多学科管理提供了契机。
