癌症爆发痛(breakthrough cancer pain, BTcP)是指相对稳定的慢性背景疼痛的癌症患者经历短暂的疼痛加重。典型的BTcP的常见临床特征主要是发作迅速,强度大,持续时间短。癌症爆发痛影响患者的生活质量,加重医疗负担。首先,有效的评估是关键。即释阿片类药物是目前BTcP的主要治疗药物。黏膜型芬太尼因起效迅速、生物利用度高、作用方便等特点,在癌症爆发痛的治疗上具有优势。本文主要从BTcP的定义、分类、病理机制、评估、管理及治疗方面进展进行综述。
Cancer patients with relatively stable chronic background pain may experience transient episodes of pain, known as breakthrough cancer pain (BTcP). Common clinical features of a typical BTP ep-isode include a rapid onset peaking within minutes, a severe intensity and a short duration. BTcP affects patients’ quality of life and increases pressure on healthcare systems. Firstly, effective as-sessment is critical. Immediate-release opioids are the mainstay of treatment for BTcP. Mucosal fentanyl has advantages in the treatment of BTcP due to its rapid effect, high bioavailability and convenience. This review presents the latest research advances on the definition, classification, pathological mechanism, evaluation, management and characteristics of different treatment methods of cancer breakthrough pain.
癌症,爆发痛,治疗, Cancer Breakthrough Pain Treatment癌症爆发痛的现状及进展
邵岚,张沂平
浙江省肿瘤医院胸部肿瘤内科,浙江 杭州
收稿日期:2019年2月14日;录用日期:2019年2月28日;发布日期:2019年3月8日
摘 要
癌症爆发痛(breakthrough cancer pain, BTcP)是指相对稳定的慢性背景疼痛的癌症患者经历短暂的疼痛加重。典型的BTcP的常见临床特征主要是发作迅速,强度大,持续时间短。癌症爆发痛影响患者的生活质量,加重医疗负担。首先,有效的评估是关键。即释阿片类药物是目前BTcP的主要治疗药物。黏膜型芬太尼因起效迅速、生物利用度高、作用方便等特点,在癌症爆发痛的治疗上具有优势。本文主要从BTcP的定义、分类、病理机制、评估、管理及治疗方面进展进行综述。
上世纪90年代,美国癌痛研究中心的Portenoy等发表在首次PAIN杂志上提出了爆发痛(Breakthrough Pain, BTP)的定义,认为爆发痛是阿片类药物治疗疼痛稳定基础上出现的疼痛短暂剧烈的发作 [7] 。但由于定位不精确,常常导致一些争议或困惑。目前最受国际认可的是2009年由英国和爱尔兰保守治疗协作委员会(Association for Palliative Medicine of Great Britain and Ireland, APM)提出的爆发痛的观点 [8] ,定义癌性爆发痛(Breakthrough Cancer Pain, BTcP)为基础疼痛控制相对稳定和充分的前提下,自发的或有相关的可知或不可知的触发因素引发的短暂疼痛加重。只要同时达到以下三个条件就可确诊为爆发痛:存在慢性癌痛的基础;近1周癌痛得到充分的控制(NRS评分 ≤ 3分);疼痛短暂的急性加重。
邵 岚,张沂平. 癌症爆发痛的现状及进展Current Research and Advances in Cancer Breakthrough Pain[J]. 临床医学进展, 2019, 09(03): 257-267. https://doi.org/10.12677/ACM.2019.93039
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