多发性骨转移瘤的综合治疗

目的 探讨治疗对多发性骨转移瘤缓解骨闯，改善生活质量的临床意义。方法 ２８８例骨转移瘤患者用止痛性放疗、化疗、内照射治疗（＾９９Ｓｒ及＾１９９Ｓｍ）、博宁（Ｐａｍｉｄｒｏｎａｔｅ）等综合治疗，并分组观察治疗后疼痛缓解及生活质量的变化。结果＾８９Ｓｒ结合止痛性放疗组疗效最佳，有效率达９４．１％与化 且及化疗加博宁组比较有统计学差异；综合治疗组总有效率为７５．４％，高于单一治疗组（Ｐ〈０．００１），     

博宁联合化疗治疗转移性骨肿瘤25例疗效观察

目的探讨帕米膦酸二钠(博宁)联合化疗对恶性肿瘤骨转移的临床疗效。方法25例恶性肿瘤骨转移患者,均接受博宁联合化疗。结果患者疼痛总缓解率为84%,骨病灶控制总有效率为28%,无明显不良反应。结论帕米膦酸二钠联合化疗是目前治疗晚期恶性肿瘤骨转移的优选方案。     

40例肢体骨肿瘤及骨转移癌瘤段切除重建

目的 探讨肢体骨肿瘤及骨转移癌行瘤段切除重建的方法和意义。方法 用5种方法30例骨肿瘤患者进行修复重建；(1)瘤段切除关节融合术；(2)瘤段切除异体半关节移植术；(3)瘤段切除人工假体置换术；(4)瘤段切除髓内针骨水泥重建术；(5)瘤灶切刮异体骨、骨水泥修复术。结果 30例骨肿瘤患者中，术后无瘤存活26例，死亡4例，其中2例局部复发而截肢。28例患者患肢功能按Ennekjng骨肿瘤外科治疗后功能评定标准，优良率达83．4％。10例11侧骨转移癌患者术后疼痛消失8例9侧，占81．8％，减轻2例，占19．2％；术后存活3个月以上者9例，占90％；恢复日常活动者8例，占80％。结论 综合评估肢体肿瘤患者的病情，选择合适的手术方法行瘤段切除修复重建，可为患者保留一个具有一定功能的肢体；适度的外科手术对于提高骨转移癌患者终末期的生存质量有积极的意义。     

球囊扩张椎体后凸成形术治疗胸腰椎转移瘤26例

 目的　探讨球囊扩张椎体后凸成形术治疗胸腰椎转移瘤的疗效和安全性。方法　2006年3月至2009年9月采用球囊扩张椎体后凸成形术治疗26例胸腰椎转移瘤,观察患者疼痛视觉模拟评分及评估生活质量。结果　26例患者VAS评分由术前的平均8.6分下降为2.0分;生活质量明显改善。未发生骨水泥渗漏到椎管现象。结论　球囊扩张椎体后凸成形术治疗胸腰椎转移瘤可有效缓解疼痛,改善患者的脊柱功能,疗效满意。     

博宁联合153Sm-EDTMP治疗恶性肿瘤多发骨转移的疗效观察

目的 :探讨博宁联合153Sm EDTMP治疗恶性肿瘤多发骨转移的临床疗效。方法 :32例恶性肿瘤多发骨转移患者随机分为 2组 ,每组 16例 ,分别接受153Sm EDTMP单独或与博宁联合治疗。结果 :联合组疼痛总缓解率 (CR PR)为 93 8% ,单用组为 62 5% ,骨病灶控制总有效率 (CR PR)联合组56 3% ,单用组为 18 8% ,联合组疗效优于单用组 (P <0 0 5) ,两组均无严重的毒副作用。结论 :博宁联合153Sm EDTMP是目前治疗晚期恶性肿瘤多发骨转移的优选方案     

经皮椎体成形术治疗溶骨性椎体转移瘤临床探讨

目的探讨经皮椎体成形术在溶骨性椎体转移瘤治疗中的临床应用与疗效。方法对9例胸腰椎溶骨性椎体转移瘤患者的14节病变椎体,采用在C臂X线机透视下行单侧经皮椎体穿刺及骨水泥灌注成形的方法治疗,术后评估疼痛缓解程度。结果所有9例患者经皮穿刺椎体成形术治疗后,疼痛显著缓解。疼痛缓解程度为优8例,良1例,无并发症发生。术后随访2-24月（平均7月）,原病变椎体未见肿瘤复发及椎体塌陷骨折。结论经皮椎体成形术在溶骨性椎体转移瘤的治疗中,不仅操作简便易行,疗效肯定,并且是一种较为安全的治疗方法,作为肿瘤联合治疗中的一种有效手段,值得临床推广。     

博宁治疗恶性肿瘤骨转移疼痛的疗效观察

目的:观察博宁(帕米膦酸二钠APD)对骨转移疼痛的临床疗效.方法:22例晚期恶性肿瘤骨痛患者静脉点滴博宁90mg一疗程,连用1～2个疗程,部分病例合并化疗(n=11)或内照射治疗(n=5).结果:博宁对骨痛的总有效率为86.3%(19/22),合并化疗、153Sm(钐)-EDTMP(乙二胺四甲基膦酸)治疗和单纯博宁治疗的有效率分别为90.9%、80.0%、66.7%.获效时间1～20天,83.3%患者在两周内获效,无明显毒副作用.结论:博宁是一种治疗恶性肿瘤骨转移骨痛的有效药物,能有效地缓解骨痛和活动功能障碍、提高患者的生活质量,与化疗、153Sm-EDTMP内照射治疗联用,疗效更好.     

帕米膦酸二钠（博宁）在减轻恶性肿瘤骨转移疼痛中的作用（附43例报告）

目的 观察帕米膦酸二钠(博宁)在减轻恶性肿瘤骨转移疼痛中的作用。方法 治疗晚期恶性肿瘤骨转移43例。男性29例,女性14例。单发骨转移3例,多发骨转移40例。结果 经用帕米膦酸二钠治疗后总有效率76.74％,其中7例患者疼痛缓解持续3个月,其他患者麻醉药及其他镇痛药用量亦大大减少,且观察中未发现明显的肝、肾功能损害及其他毒副作用。结论 帕米膦酸二钠(博宁)治疗骨转移性疼痛见效快且疗效肯定,是治疗骨转移疼痛安全而有效的药物。     

博宁治疗35例恶性骨转移口才临床分析

目的：探讨博宁对恶性肿瘤骨转移的治疗作用及骨骼修复作用。方法：３５例患者接受博宁单独或联合化疗治疗。结果：骨痛总缓解率为８０．０％，单用博宁及博宁联合化疗两组之间无明显差异，有效率分别为７６．５％和８６．３％，疼痛缓解与病种之间也未发现明显差别，博宁应用后疼痛缓解的显效时间为２￣１５天，平均为４天左右，２８例患者疼痛解后有１１例患者再次出现疼痛复发，时间为用药后１￣４个月，平均３个月，治疗后血清离     

~(89)SrCl_2治疗转移性骨肿瘤的临床应用初析

（目的）探讨(89)SrCl2治疗转移性骨肿瘤临床应用价值。（方法）19例有不同程度骨痛（伴或不伴活动受限）的广泛转移性骨肿瘤患者，接受了(89)SrCl2治疗（静脉注射），剂量为2．22MBq（60uCi）kg。(89)SrCl2治疗后随访时间最短3个月，最长1．2年。（结果）本组19例有4例疼痛基本消失，活动能力明显恢复，复查骨显像异常浓聚明显缩小和（或）减少．为显效；13例疼痛明显减轻，活动能力改善，为有效；2例疼痛无明显变化，活动能力无改善，为无效，有效率达89．5％。有效者中疗效维持时间最长已超过1年。部分病例治疗后4周左右白细胞计数略有下降，血象的变化与疗效无明显相关性。（结论）用(89)SrCl2治疗转移性骨肿瘤主要作用是镇痛，使大多数病人的生活质量得以改善。部分病人病灶缩小或消失，起到了缓解病情、延长生命的作用。     

Difficult pain syndromes: bone pain, visceral pain, and neuropathic pain

Cancer pain is prevalent in approximately two thirds of all cancer patients and can undermine the quality of life in this patient population. Uncontrolled pain can cause physical as well as psychological distress in cancer patients. As the disease progresses in cancer, pain and suffering increase. Knowledge about pain management is paramount in the comprehensive treatment of cancer patients. Difficult cancer pain syndromes may arise from interruption of bone, viscera, and neural structures by malignant spread of the disease. Familiarity with opioids, adjuvants, and procedures that can abate pain in cancer patients is discussed in a practical manner for clinical application in this text.     

Challenges in cancer pain management--bone pain

Whilst not strictly a neuropathic injury, cancer-induced bone pain (CIBP) is a unique state with features of neuropathy and inflammation. Recent work has demonstrated that osteoclasts damage peripheral nerves (peptidergic C fibres and SNS) within trabeculated bone leading to deafferentation. In addition, glia cell activation and neuronal hyperexcitability within the dorsal horn, are all similar to a neuropathy. Gabapentin and carbamazepine (both anti-convulsants that modulate neuropathy) are effective at attenuating dorsal horn neuronal excitability and normalizing pain-like behaviours in a rat model of CIBP. However alterations in neuroreceptors in the dorsal horn do not mimic neuropathy, rather only dynorphin is upregulated, glia cells are active and hypertrophic and c-fos expression is increased post-noxious behavioural stimulus. CIBP perhaps illustrates best the complexity of cancer pains. Rarely are they purely neuropathic, inflammatory, ischaemic or visceral but rather a combination. Management is multimodal with radiotherapy, analgesics (opioids, NSAIDs), bisphosphonates, radioisotopes and tumouricidal therapies. The difficulty with opioids relates to efficacy on spontaneous pain at rest and movement-related pain. Potential adjuvants to standard analgesic therapies for CIBP are being explored in clinical trials and include inhibitors of glutamate release.     

Post-tonsillectomy pain: Different modes of pain relief

Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p < 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p <0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant reduction of VAS (p< 0.01) immediately after TENS therapy at 0, 4 and 8 hours. Rescue analgesic consumption was significantly lower in TENS group. Thus, TENS seems to be an effective therapeutic modality for post tonsillectomy pain relief as compared to the other two methods.     

癌症患者疼痛量表的应用

癌痛本质上是患者的主观感受,因此患者的疼痛表述是评估的依据,患者自评量表也由此在临床实践和研究中被广泛采用。一维量表常用于评估癌痛的强度,其中的数字评估量表（Numerical Rating Scale,NRS）被欧洲姑息治疗研究协作组所推荐;多维量表,如简式疼痛问卷（Brief Pain Inventory,BPI）或修订后的简式麦吉尔疼痛问卷（Short-Form McGill Pain Questionnaire,SF-MPQ-2）可更全面的评估癌痛;评估肿瘤患者的爆发痛、神经病理性疼痛时可选择有针对性的量表;对认知功能受损的患者,脸谱法评估有助于癌痛筛查,要评估癌痛还需采用多维量表。无论选择何种评估工具,均强调对癌痛进行动态评估。简便易行的电子评估量表是目前癌痛新量表研制的趋势。      

Nurses' perceptions of their pain assessment skills, pain management practices, and attitudes toward pain

Nursing pain assessments are influenced by the length of available tools, patient characteristics, patient pathology, concern about addictive behavior, and characteristics of the nurse. The relationship among these variables was explored in a sample of community hospital nurses (N = 59) and ONS members (N = 19). Although a number of interesting similarities were found in the two groups, age, professional and continuing education, and care setting appear to be related to differences in pain assessment practices. Implications for practice, research, and education include teaching nurses to: assess factors related to quality of life in the pain experience, assess and validate data from families, assess coping skills, and teach patients to use behavioral pain management strategies. The findings also suggest that further study is needed concerning the relationship between personal beliefs and experiences and the assessment and management of pain. Membership in professional organizations appears to be associated with comprehensive approaches to the assessment and management of cancer pain and should be addressed in further research.     

Transformation of acute cancer pain to chronic cancer pain syndromes

For many cancer survivors, disease-related long-term morbidities and the application of advanced cancer treatments have resulted in the development of a chronic pain state. This brief review explores the relationship between what is known about the treatment of active cancer pain syndromes-both continuous pain and breakthrough pain-and persisting pain syndromes in cancer survivors. We also posit that because there is evidence to suggest that poorly treated acute pain can lead to protracted pain conditions, acute pain should be recognized and treated promptly, both for short- and long-term gain. In the short term, better acute pain treatment can improve functionality and psychological well-being, whereas in the long term, mounting evidence suggests that it could prevent of future chronic pain.     

Cancer-related pain

Cancer-related pain affects approximately 90% of those in all stages of the disease. Pain is both a sensation and an emotional experience, and thus it has been defined as total pain. The type of cancer pain management decided upon depends on the underlying pathophysiological mechanisms, which are classified as nociceptive(somatic and visceral), neuropathic, and idiopathic. Pain management as part of routine cancer care has been forcefully advanced by the World Health Organization( WHO)-analgesic ladder. The clinical application of pain management should be employed only after a complete and comprehensive assessment and evaluation. The present overview article focuses on nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and adjuvant analgesia.     

Management of cancer pain: basic principles and neuropathic cancer pain

Pain is one of the commonest symptoms in patients with cancer occurring in as many as 90% of patients during their illness. Pain is a complex phenomenon, which can be exacerbated by numerous other factors. This paper discusses the common strategies for the management of cancer pain in general and also neuropathic cancer pain. Using the World Health Organisation (WHO) analgesic ladder for cancer pain relief, 80% of cancer pain can usually be controlled. It follows therefore that 20% of cancer pain can be difficult to control. Neuropathic cancer pain is often in this category and the use of adjuvant analgesics such as amitriptyline and gabapentin is important. Optimum cancer pain control is achieved by integrating standard analgesic approaches during tumouricidal therapy or any other active cancer treatment.     

癌症疼痛的治疗

癌痛是影响癌症患者生活质量的重要因素,其产生有着复杂的机制,治疗的关键是针对病因学的治疗,包括化疗、放疗、手术、止痛药物、中医中药、认知心理等。有效的治疗可缓解癌痛,提高患者生活质量。对疼痛进行评估,选择个体化的治疗方案是缓解癌痛的重要措施。