癌痛药物治疗的新观念

癌痛治疗，尤其对于晚期癌症患者的治疗，是一个世界性的问题。为帮助患者坚持完成完整的放疗及化疗，最大限度地减轻患者的痛苦，提高生活质量，WHO提出到2000年世界范围内“让癌症患者不痛”的目标。1990年我国卫生部下达“癌症患者三级镇痛阶梯治疗”的通知。从WHO阶梯镇痛方案在我国推广10a来的情况看，中国麻醉镇痛药品的应用与发达国家相     

癌痛的评估与治疗的新观念

癌性疼痛是世界性的问题,癌症的预防,早期诊断和早期治疗被并列为WHO的4项重点规划[1]。癌性疼痛不仅严重影响患者的生活质量,而且易使患者失去生活勇气,恶化身体状况。因此,分析疼痛原因、正确评估癌痛、及时有效地处理极为重要。1癌性疼痛的评估1.1视觉模拟评分法(ViraalAual     

癌性痛的药物治疗

癌症发生后可出现各种躯体症状并受心理和情绪状态的影响,其中癌性痛是具有代表性的症候群,有效镇痛需综合躯体、精神、社会心理等多方面因素.本文介绍癌性痛的流行病学、综合性评估,重点归纳癌性痛的药物治疗.     

疼痛门诊采用药物治疗癌痛的临床研究

目的:探究疼痛门诊中癌痛应用药物治疗的临床价值、疗效。方法:抽取于我院疼痛门诊进行诊治的癌痛患者80例,采取随机原则分为对照组和观察组,各40例。对照组应用单一阿片类药物治疗,观察组在对照组的基础上加用氨酚羟考酮片药物治疗,观察两组疼痛程度、治疗有效情况、生活质量、并发症发生情况。结果:治疗有效率观察组为97.50%(39/40),对照组为75.00%(30/40),差异存在统计学意义,P<0.05(χ^2=8.5375);观察组并发症发生率为10.00%(4/40),对照组是57.50%(23/40),差异具有统计学意义,P<0.05(χ^2=22.7262);观察组的疼痛情况显著优于对照组,差异具有统计学意义,P<0.05。结论:癌痛应用阿片类药物联合氨酚羟考酮片药物治疗效果显著,可有效降低疼痛程度,减少并发症,提高生活质量。     

癌痛治疗的辅助用药

疼痛始终是癌症患者在其整个病程中的主要问题,也是其患者和家属的最大梦魇。在初诊断癌症的患者中大约有25~30%的人有疼痛症状,有超过80%的晚期癌症患者有疼痛症状,90%的骨转移患者向医生诉说疼痛,即使在积极治疗癌症的患者中也有1/3的患者有不同程度的疼痛[1,2]。     

癌痛的药物治疗与手术治疗

癌痛是肿瘤患者最恐惧的症状之一,常比癌症引起的死亡更令人畏惧。癌痛不仅使患者感到难受,而且还会带来一系列严重的影响,会加速肿瘤的发展;恶心呕吐、食欲减退焦虑、恐惧、抑郁、不愿与人交往;各种机体功能减退,活动能力下降;对生活和治疗失去信心等。疼痛对身体、生理和心     

癌性疼痛的药物控制及治疗新观念

疼痛是肿瘤患者最常见却又最难控制的症状之一。据WHO统计全世界每年有1000万新发癌症患者,600万人死于癌症,其中50％的患者有癌性疼痛症状,70％的晚期癌症患者以疼痛为主要症状。癌性疼痛（cancerpain）是指由癌症、癌症相关性病变及抗癌治疗所致的疼痛,常为慢性疼痛,是癌症患者的常见症状。包括由肿瘤直接引起的疼痛;肿瘤侵犯或压迫神经根神经干、神经丛或神经;     

甘露醇对癌痛止痛效果临床观察

目的：通过临床应用甘露醇,观察其对１０８例恶性肿瘤疼痛的止痛效果及实用性。方法：ｉｖｇｔｔ２０％甘露醇２５０ｍｌ,随机分为ｑｄ组和ｂｉｄ组,对两组止痛效果进行比较;对恶性肿瘤放射治疗病例,分为单纯放射治疗组和放射治疗加ｉｖｇｔｔ甘露醇组,观察放射治疗引起４、５、６级疼痛出现率。结果：ｉｖｇｔｔ２０％甘露醇ｍｌ,ｑｄ和ｂｉｄ组,止痛效果ＣＲ分别为６８．５％和７０．６％（ｐ〉０．０５）;单纯放射治疗组     

癌痛的阿片类药物治疗应更新用药观念

癌痛是一个世界性的问题 ,尤其是晚期癌症患者[1] 。为了帮助患者坚持完成放疗及化疗过程、最大限度地减轻患者的痛苦、提高其生活质量 ,WHO提出到 2 0 0 0年世界范围内“让癌症患者不痛”的目标。 1990年我国卫生部下达了关于“癌症病人三级止痛阶梯治疗”的通知。从WHO三阶梯止痛方案在我国推广 10年来的情况看 ,中国麻醉止痛药品的应用与发达国家相比还存在差距 ,在 1999年全球麻醉药品消耗量排名中 ,中国排在第 10 2位。与邻国日本相比 ,人口是日本的 10倍多 ,实际吗啡人均消耗量是日本的百分之一[2 ] 。影响癌痛治疗的原因是多方面…     

The treatment of cancer pain

Pain is probably one of the most common cancer symptoms. In addition to being a major source of suffering and disability, cancer pain is extremely frightening for patients and their families. This review discusses the current options for treating cancer pain, focusing on the pharmacological agents currently available and briefly exploring some of the surgical options for pain management. The authors propose to adjust the World Health Organization (WHO) pain management ladder from its current three-step approach to a more sophisticated five-step algorithm that includes physical and psychological modalities along the entire continuum of care and adds two more steps related to neuromodulative and neurodestructive procedures once the opioids fail.     

胃癌的内科药物个体化治疗

胃癌在我国的发病率和病死率较高。内科治疗在胃癌的辅助治疗和姑息治疗中都占据重要的位置。随着近年来新型化疗和靶向药物的应用,胃癌的内科治疗水平不断提高,临床选择也日益多样化。对于胃癌这种具有高度异质性的疾病,内科个体化治疗是全面提升疗效的重要途径。文中对近年的有关进展做一综述。     

肝癌内科治疗研究进展

原发性肝癌的死亡率在恶性肿瘤死因中位居第3,患者的预后很差.涵盖外科、局部消融、肝动脉化疗栓塞、放疗、分子靶向和免疫治疗等的规范化多学科综合治疗是当前肝癌的主要治疗模式.本文概要介绍肝癌的内科治疗研究进展.     

The use of opioids for treatment of cancer pain

Introduction: Pain is commonly experienced by patients with cancer, particularly those with advanced disease. Alleviating pain is an important goal of cancer treatment. Opioids are the cornerstone of the analgesic treatment.

Areas covered: Pharmacology, characteristics, and use of opioids in clinical practice are presented.

Expert opinion: Although the use of opioids is largely accepted as a fundamental step for controlling cancer pain, existing data supporting this statement are poor. All opioids provide analgesia and are effective in controlling cancer pain. New drugs have been developed and experience is accumulating among clinicians. Despite these drugs having different pharmacokinetic and chemical properties, there is no proof that one opioid is better than another one. Thus, the optimum benefit depends on the experience of the users. Clinicians should weight evidence, clinical experience, patient preferences, and treatment costs when choosing the optimal treatment for an individual patient with cancer pain. New opioids with specific receptor activities are under investigation.     

New trends for the medical treatment of endometriosis

INTRODUCTION: Endometriosis is a benign sex hormone-dependent gynecological disease, characterized by the presence and growth of endometrial tissue outside the uterus; it affects 10% of women of reproductive age and is associated with infertility and pain. Treatment of endometriosis involves conservative or radical surgery, or medical therapies. The goals for endometriosis treatment may be the relief of pain and/or a successful pregnancy achievement in infertile patients. Treatment must be individualized with a multidisciplinary approach. The classical treatments carry adverse side effects and in some cases a negative impact on quality of life. New agents promise a distinct perspective in endometriosis treatment. AREAS COVERED: The aim of this paper is to systematically review the literature evidence of new medical treatments for endometriosis, defined as pharmacological treatments not yet commonly available and currently under investigation. EXPERT OPINION: These new medical therapies would be used associated with surgical treatment and, in the future, will render possible the association of hormone therapy with non-hormonal treatment for endometriosis.     

Fentanyl nasal spray for the treatment of cancer pain

Introduction: Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated.

Areas covered: Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients.

Expert opinion: The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.     

Fentanyl nasal spray for the treatment of cancer pain

INTRODUCTION: Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated. AREAS COVERED: Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients. EXPERT OPINION: The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.     

New investigational drugs for the treatment of neuropathic pain

Introduction: Neuropathic pain (NP) is a chronic condition that arises from a lesion or dysfunction of the somatosensory nervous system. However, there are several new targets and novel technologies in the pipeline to address this unmet medical need.

Areas covered: In this review, the authors briefly discuss a direction of the development of agents that could be potentially used in NP treatment. Special attention is paid to 1.7-selective voltage-gated sodium channels, N-type voltage-gated calcium channels, angiotensin II (Ang II) AT₂ receptors and nerve growth factor (NGF) as promising targets for new drugs. Furthermore, the article also presents and discusses, in detail, the results of Phase II clinical studies with the AT₂ receptor antagonist ? EMA401 in NP (the results of Phase II clinical trials of other described compounds are not available, yet).

Expert opinion: There is a real hope that new drugs for NP may be available soon. This hope is based on advancing methods of genomics, developing new targets and more efficient drug screening. Some forms of direct influence on voltage-gated ion channels have a place in the treatment of NP, while the development of entirely novel Ang II AT₂ receptor antagonists or NGF inhibitors may be available for many chronic pain sufferers in the foreseeable future.