超大剂量羟考酮联合多种方式管理难治性癌痛一例报道

Multidisciplinary combined management of refractory cancer pain under mega-dose oxycodone analgesia:One case report

癌痛是中晚期的肿瘤患者常见的临床症状,基于美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)成人癌痛临床实践指南2022版,癌痛患者服用阿片类药物无天花板效应,应根据个体化用药原则,按疼痛程度不同给药,治疗剂量的选择个体化差异非常大,且大剂量用药会出现明显的不良反应。本文报道1例临床应用超大剂量羟考酮镇痛,期间未发生不良安全事件,属于临床典型用药案例。同时本病例在治疗过程中除加大口服羟考酮剂量外,尝试联合多种方式如放化疗控制肿瘤进展,并使用氩氦刀、神经阻断等管理难治性癌痛,有效缓解了患者的疼痛。目前维持超大剂量羟考酮给药有效改善了患者癌痛,为治疗难治性癌痛提供一定的临床经验与方法。

Cancer pain is a common clinical symptom in patients with intermediate to advanced cancer.Based on the NCCN adult cancer pain clinical practice guideline 2022 edition,patients with cancer pain taking opioids have no ceiling effect and should be treated according to the principle of individualized medication,according to the degree of pain,the choice of therapeutic dose is highly individualised,and large dose has obvious adverse reactions.This paper reports a typical clinical case of mega-dose oxycodone analgesia without adverse safety events.In addition to increasing the oral dosage of oxycodone,the patient tried to control the progression of the tumor by combination of radiotherapy and chemotherapy,and managed the refractory cancer pain by argon-helium cryoablation and nerve block,which effectively relieved pain in patients.At present,the mega dose of oxycodone can improve the cancer pain effectively,and provide some clinical experience and methods for the treatment of refractory cancer pain.