课件：癌症患者的疼痛控制.ppt

* Neuropathic pain results from damage to neural structures and can have a great variety of presentations. The affected patient often complains of dysesthesias (abnormal pain complaints) that are new to the patient. The pain may be described as burning, tingling, or shock-like. Other findings may include allodynia (pain on light touch), hyperalgesia, and hypalgesia (altered sensitivity to noxious stimuli). Neuropathic pain is relatively resistant to opioids and therefore usually requires the addition of adjuvants such as antidepressants and anticonvulsants. * Incident pain is the pain associated with body movement and is usually treated in the same way as breakthrough pain. The measures below may also help: Optimize background analgesia with long-acting opioids. Treat exercise-related pain with anticipatory analgesia (take a breakthrough dose 30 minutes before exercise). Use non-opioids and adjuvants appropriately. Consider other modalities such as radiotherapy, nerve blocks, and stabilizing surgery. * Mild pain can be treated with a Step 1 analgesic such as acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If pain persists or worsens, a change to a Step 2 or 3 analgesic is indicated. Most patients with cancer pain will require a Step 2 or 3 analgesic. Frequently, Step 1 is skipped in patients presenting initially with moderate-to-severe pain. At each step, an adjuvant drug or modality such as radiotherapy can be considered in selected patients. 從世界衛生組織(WHO)的用藥建議中，當一個癌症病人為〝輕度疼痛〞時，使用非鴉片止痛藥止痛，而當一個癌症病人為〝中重度疼痛〞時， 此時不需先用非鴉片止痛藥，則應馬上使用 鴉片止痛藥止痛。 * The effectiveness of acetaminophen and NSAIDs is usually limited to relief of mild somatic pain. A recent meta-analysis suggests that NSAIDs generally do not significantly spare opioid doses.[1] Patients taking acetaminophen or NSAIDs, including elderly patients (60y/o) and patients with chronic disease (renal or hepatic disease or cardiac failure), should be followed carefully for side effects.[2] These agents