Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives.
Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives.
复制标题
DOI：
10.14694/edbk_180469
复制
发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Wallace, Mark
中科院分区：
文献类型：
--
作者：
Bennett, Mike;Paice, Judith A;Wallace, Mark
疼痛在恶性肿瘤中仍然很常见，是癌症及其治疗的结果。一些高质量的研究证实，超过50%的癌症患者经历中度至重度疼痛。癌症幸存者中疼痛的患病率估计为40%，而近三分之二的晚期癌症患者生活在疼痛中。癌症疼痛的管理已经取得了进展，但治疗不足的情况仍然存在。此外，新的挑战正在威胁这些进展。这些挑战是多方面的，包括教育不足、时间限制和获得各种护理的机会有限。由于旨在打击处方药滥用流行病的干预措施，越来越少的临床医生愿意开阿片类药物，药店不愿意储存药物，付款人对报销实行严格限制，因此在获得药物方面出现了新的挑战。一个相关的挑战是我们对与阿片类药物相关的长期不良反应风险的认识不断发展。反映了阿片类药物滥用流行病影响了一般人群，滥用或滥用的可能性存在于癌症患者中。已经制定了指导方针，以支持肿瘤学家为癌症幸存者长期使用阿片类药物。围绕阿片类药物使用的挑战，以及对安全有效的替代镇痛药的需求，正在引起人们对大麻对癌症相关疼痛的潜在益处的浓厚兴趣。肿瘤学家面临的问题涉及可用的大麻类型、给药途径之间的差异、有关安全性和有效性的数据以及法律的和监管动态。
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care. New challenges to access are occurring as a result of interventions designed to combat the prescription drug abuse epidemic, with fewer clinicians willing to prescribe opioids, pharmacies reluctant to stock the medications, and payers placing strict limits on reimbursement. A related challenge is our evolving understanding of the risks of long-term adverse effects associated with opioids. And reflective of the opioid abuse epidemic affecting the general population, the potential for misuse or abuse exists in those with cancer. Guidelines have been developed to support oncologists when prescribing the long-term use of opioids for cancer survivors. The challenges surrounding the use of opioids, and the need for safe and effective alternative analgesics, are leading to intense interest in the potential benefits of cannabis for cancer-related pain. Oncologists are faced with questions regarding the types of cannabis available, differences between routes of administration, data concerning safety and efficacy, and legal and regulatory dynamics.