鴉片類藥物於癌症疼痛治療的最新觀念

New Concepts of Opioids in Cancer Pain Management

黃安年(On-Nin Wong) ； 陳多慕(Dou-Moo Tan) ； 儲寧瑋(Ning-Wei Cheu) ； 王俞人(Yu-Ren Wang) ； 廖健雄(Chien-Hsiung Liao) ； 陳怡靜(Yi-Ching Chen) ； 華淑芳(Mary Paul Watts)

《安寧療護雜誌》 15卷2期 (2010/07) Pp. 196-205

https://doi.org/10.6537/TJHPC.2010.15(2).5

摘要

對於治療中等度至嚴重度之癌症疼痛，鴉片類藥物是目前最常用及最有效的止痛藥，屬於該等級疼痛治療的第一線用藥，但對於使用上可能發生之副作用仍須密切的監視。其他相關的治療方法，例如加入輔助止痛藥物的「合併療法」(Combination therapy)及鴉片類藥物的「轉換」或「輪替」(Opioid switching or rotation)，必須在適當時機考慮使用，以減少鴉片類藥物的副作用，並維持足夠的止痛效果。同一位病人的癌病疼痛，常出現多種複雜的機轉，病人對鴉片類藥物的效果，具有個別變異的特性，無法用單一的機轉解釋；因此，多元整合式的治療(Multidisciplinary treatment)是目前最理想的選擇。目前對於轉移性骨頭痛的治療，己有較新之進展；對於癌症誘導之骨頭痛，己有很多新藥在進行臨床試驗；同時，臨床研究顯示，一些藥物及方法，例如Cyclooxygenase-2 (COX-2)抑制劑及鴉片類藥物輪替等，可考慮作爲改善鴉片類藥物之不良反應，例如鴉片類藥物誘發之痛覺過度(Opioid-induced hyperalgesia)及止痛藥物的耐受性等，以增加其治療效果。未來的研究將著重於長期暴露於鴉片類藥物對疼痛及疾病進展的影響，以提供重要資訊作爲改善長時期之癌症疼痛的治療。

關鍵字

鴉片類藥物 ； 癌症疼痛 ； 癌痛病人 ； 最新觀念

並列摘要

Opioids are the most common and effective treatment for moderate to severe cancer related pain, and they remain the first-line medications for those suffering from severe pain. However, care must be taken to closely monitor patients for potential adverse effects of opioids. Alternatives, such as combination therapy with co-analgesics, opioid switching and rotation must be considered and appropriately used to minimize opioid-induced adverse effects, and to maintain the analgesic efficacy of opioid treatment. Multiple mechanisms may contribute to cancer-induced pain, and no single mechanism adequately explains the intraindividual or interindividual variability observed with opioids. Therefore, multidisciplinary treatment may be the best solution for their pain management. New drugs are undergoing clinical trials for cancer-induced bone pain; and some medications like COX-2 inhibitors, as well as other techniques like opioid rotation, may be considered to ameliorate side effects of such opioids as opioid-induced hyperalgesia and analgesic tolerance. Furthermore, investigations in the effects of prolonged opioid exposure on pain processing and disease progression will provide important insights as to potential improvements in long-term management of chronic cancer pain.

並列關鍵字

Opioids ； Cancer pain ； New concept