Zenz M, Roth S L, Strumpf M
Klinik für Anästhesiologie, Intensiv- und Schmerztherapiel, Universitätsklinik Bergmannsheil, Bochum.
Praxis (Bern 1994). 1998 Sep 2;87(36):1126-34.
Overall, pain is one of the most common symptoms associated with cancer and often produces greater anticipatory distress than other features of the disease. Drug selection depends on the intensity of pain rather than on the specific pathophysiology. Mild to moderate pain can often be treated effectively by so-called "weak" opioids. Non-opioid analgesics, like acetyl-salicylic acid or paracetamol can be added according to the "analgesic ladder" proposed by the World Health Organization (WHO). Opioids should be given on a fixed time schedule thereby, preventing pain from recurring. Additional rescue doses (approximately 50 degrees, of baseline single dose) are given for breakthrough pain. Noninvasive (oral, rectal, sublingual, transdermal and intranasal) routes of application should be maintained as long as possible to preserve independence and mobility. When treatment by infusion therapy (subcutaneous, intravenous, epidural) has been elected, the addition of patient controlled analgesia (PCA), which permits patients to administer a preset amount of narcotic at preset intervals, is an effective means to manage breakthrough and incident pain in selected patients. Antidepressants, anticonvulsants and some antiarrhytmics are used as co-analgesics. Oral medication alone can guarantee pain relief in about 95% of the patients. The WHO analgesic ladder has proven effective in all settings of patients care.
总体而言，疼痛是癌症最常见的症状之一，通常比疾病的其他特征产生更大的预期痛苦。药物选择取决于疼痛的强度而非特定的病理生理学。轻度至中度疼痛通常可用所谓的“弱”阿片类药物有效治疗。可根据世界卫生组织（WHO）提出的“镇痛阶梯”添加非阿片类镇痛药，如乙酰水杨酸或对乙酰氨基酚。阿片类药物应按固定时间表给药，从而防止疼痛复发。对于爆发性疼痛，给予额外的解救剂量（约为基线单次剂量的50%）。应尽可能长时间维持非侵入性（口服、直肠、舌下、透皮和鼻内）给药途径，以保持独立性和活动能力。当选择通过输注疗法（皮下、静脉、硬膜外）进行治疗时，添加患者自控镇痛（PCA），允许患者在预设间隔自行给药预设量的麻醉剂，是管理特定患者爆发性和偶发性疼痛的有效手段。抗抑郁药、抗惊厥药和一些抗心律失常药用作辅助镇痛药。仅口服药物就能保证约95%的患者疼痛得到缓解。WHO镇痛阶梯已在所有患者护理环境中证明有效。
