Translational medicine: cancer pain mechanisms and management
Translational medicine: cancer pain mechanisms and management
复制标题
DOI：
10.1093/bja/aen100
复制
发表时间：
2008-07-01
影响因子：
9.8
通讯作者：
Fallon, M.
中科院分区：
文献类型：
--
作者：
Delaney, A.;Fleetwood-Walker, S. M.;Fallon, M.
癌症引起的骨痛(CIBP)是一个主要的临床问题，高达85%的骨转移患者有疼痛，通常与焦虑和抑郁有关，表现状态下降，生活质量差。恶性骨病通过脊髓内的敏化和突触可塑性产生慢性疼痛状态，放大伤害性信号并将其传递到大脑。50%的患者有望在治疗后4-6周内从姑息放射治疗中获得足够的止痛。阿片类止痛确实对CIBP的治疗做出了有益的贡献，特别是在抑制紧张性背景疼痛方面。然而，CIBP仍然是一个临床挑战，因为自发的和运动相关的成分更难用阿片类药物和常用的止痛药治疗，而且没有不可接受的副作用。最近开发的CIBP实验室模型与临床综合征一致，有助于更好地理解CIBP的神经生物学。这种慢性疼痛综合征似乎是独特的，不同于其他慢性疼痛状态，如炎症性或神经性疼痛。这对治疗和未来疗法的发展具有明显的影响。在临床和实验室之间使用高度迭代的过程的转化医学方法，可能会使对CIBP潜在机制的更好理解迅速转化为改善疼痛管理方面的真正临床好处。
Cancer-induced bone pain (CIBP) is a major clinical problem with up to 85% of patients with bony metastases having pain, often associated with anxiety and depression, reduced performance status, and a poor quality of life. Malignant bone disease creates a chronic pain state through sensitization and synaptic plasticity within the spinal cord that amplifies nociceptive signals and their transmission to the brain. Fifty per cent of patients are expected to gain adequate analgesia from palliative radiotherapy within 4-6 weeks of treatment. Opioid analgesia does make a useful contribution to the management of CIBP, especially in terms of suppressing tonic background pain. However, CIBP remains a clinical challenge because the spontaneous and movement-related components are more difficult to treat with opioids and commonly used analgesic drugs, without unacceptable side-effects. Recently developed laboratory models of CIBP, which show congruency with the clinical syndrome, are contributing to an improved understanding of the neurobiology of CIBP. This chronic pain syndrome appears to be unique and distinct from other chronic pain states, such as inflammatory or neuropathic pain. This has clear implications for treatment and development of future therapies. A translational medicine approach, using a highly iterative process between the clinic and the laboratory, may allow improved understanding of the underlying mechanisms of CIBP to be rapidly translated into real clinical benefits in terms of improved pain management.