阿片类药物静脉应用及多模式镇痛下的癌痛治疗

The applications of intravenous opioids and multimodal analgesia in cancer pain management

难治性癌性疼痛是全球肿瘤和疼痛医师所面临的治疗难题。虽然较多癌痛患者在疾病早期能获益于口服镇痛药物,但是对于疾病晚期和已出现难治性癌痛的患者,单纯的阿片类药物口服治疗效果较差,而此时将阿片类药物的给药途径更换为静脉仍然是最常使用的快速镇痛方法。目前,随着阿片类药物经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)的临床实践不断增加,对该方式的适应证、药物选择、滴定等问题均有了更为深入的探讨。此外,在多模式镇痛的快速发展中,癌痛治疗的个体化措施有了更广阔的延伸空间。本文将对上述问题分别进行综述,旨在对难治性癌痛治疗方案的优化提供参考。

The management of refractory cancer pain remains a challenge for oncologists and pain physicians worldwide. Although a large number of patients with cancer pain benefit from oral analgesics in the early stages, single oral opioids tend to be less effective in patients with the advanced disease and refractory cancer pain; for this, intravenous opioid administration is the most commonly used rapid analgesic option. Currently, the increasing clinical use of opioid-patient controlled intravenous analgesia（PCIA） has generated extensive discussion on its indications, drug selection, titration, and other related topics. In addition, with the rapid development of multimodal analgesia, the individualized measures for cancer pain management show a broader exploratory scope. We will review the above topics in this article with the hope of providing some references for treatment optimization in refractory cancer pain management.