神经病理性癌痛的临床特点与现状控制的调查研究

A SURVEY OF CLINICAL CHARACTERISTICS AND CONTROL OF NEUROPATHIC CANCER PAIN

目的:本研究旨在通过对神经病理性癌痛(NCP)的发病率和诊疗现状的调查,以寻求更好地控制NCP。方法:运用描述性研究方法,对658例癌痛患者临床特点进行横断面调查,对治疗进行前瞻性随访。NCP诊断标准依照NeuPSIG神经病理性疼痛的最新定义和ID-Pain量表。治疗方案依据NCCN成人癌痛治疗指南,包括镇痛辅助药物、姑息性放化疗和手术,研究周期为3周。结果:符合NP诊断者147例,纳入ITT统计118例。侵犯神经常见于腰骶丛、颈丛、臂丛。临床症状以麻木感、针刺痛和烧灼痛多见。疼痛NRS基础评分5.0±1.4,第3天降至3.7±1.5(P<0.001)。感觉超敏第3天改善(P=0.020)。烧灼痛、电击痛第7天改善(P=0.003,0.018)。生活质量第3天改善(P=0.002)。结论:NCP发病率为22.3%。采用阿片药物为主的综合治疗,多数神经病理性癌痛明显减轻。针刺样痛和麻木感较烧灼痛、电击痛和感觉过敏更加难以控制。

Objective： To investigate clinical features of neuropathic cancer pain and to evaluate its treatment statergies（NCP） and to improvement. Methods： A cross-sectional survey was conducted. 658 patients with cancer pain were investigated and evaluated. The diagnosis of NP was based on the recommendations provided by Assessment Committee of the Neuropathic Pain Special Interest Group（NeuPSIG） of the International Association for the Study of Pain（IASP）. The included criteria should also meet at least 1 point score by ID-Pain scale. Treatments were based on the NCCN Adult Cancer Pain Guideline which included three-ladder analgesics, adjuvants, palliative radiotherapy, chemotherapy and surgery. The whole study period was three weeks. Results：147 patients（22.3%） were diagnosed with NCP. 118 patients were enrolled in the ITT group for analysis. The most common types of primary cancer were lung, breast, head and neck. The main cause of NP was tumor infiltration and invasion. Lumbosacral plexus, cervical plexus and brachial plexus were involved frequently as a result of tumor infiltration. Numbness, prickling and burning was the most common NCP symptoms. Baseline NRS was 5.0±1.4, and dropped to 3.7±1.5 on Day 3（P 0.001）. Allodynia was relieved from Day 3（P = 0.020）. Symptoms of burning and electric shock were relieved from Day 7（P = 0.003, and 0.018, respectively）. Numbness and prickling wasn＇t relieved during the whole study period. Quality of life was improved on Day 3（P = 0.002）. Systemic analgesia was supported by palliative radiotherapy（24.6%）,chemotherapy（6.8%）,and surgery（5.1%）. Analgesics was the most effective way in general pain control（89.8%）. All treatment regimes had similar efficcacy in the relief of NCP symptoms（25.0% - 34.9%）. Conclusion： Neuropathic cancer pain can be better controlled by multimodal analgesic regiment following NCCN guideline in majority patients. Symptoms of numbness and prickling are more poorly controlled compared with burning, electric shock and allodynia.