難控制性疼痛：鴉片類藥物誘發之痛覺過度或潛藏的癌症惡化？：一個案報告

Difficult Pain Control: Opioid-Induced Hyperalgesia or Hidden Malignancy Progression: A Case Report

余宛蓁(Wan-Chen Yu) ； 陳如意(Ru-Yih Chen) ； 薛光傑(Kuang-Chieh Hsueh) ； 李明謙(Ming-Chien Lee) ； 江允志(Yung-Chih Chiang)

《安寧療護雜誌》 19卷1期 (2014/03) Pp. 98-105

https://doi.org/10.6537/TJHPC.2014.19(1).8

摘要

鴉片類藥物是治療中重度疼痛的主流。鴉片類使用帶來的問題除了依賴、成癮及耐受性之外，鴉片類藥物誘發的痛覺過度（Opioid-induced hyperalgesia, OIH）是近年受到熱烈討論的副作用議題之一。它是鴉片類藥物暴露造成感覺接受性敏感化的狀態，其臨床表現與耐受性類似，但OIH會因調高鴉片類劑量而疼痛惡化。診斷OIH必須先排除原本疾病進展。本篇報告一位已使用高劑量嗎啡卻仍出現頑固性疼痛的頰癌患者，初期被診斷有OIH情形，但依照OIH治療建議予以處置，仍無法有效緩解疼痛。重新安排影像檢查，卻發現符合疼痛表現的器質性病灶，經緩解性放射線治療獲得改善的治療經驗。文中亦介紹OIH的可能機轉、臨床表現、診斷及治療等。

關鍵字

鴉片類藥物誘發之痛覺過度 ； 癌症疼痛 ； 難控制性疼痛

並列摘要

Opioids are the mainstays of management of moderate to severe pain. The problems regarding the use of opioids include not only dependence, addiction and tolerance, but also opioid-induced hyperalgesia (OIH), which is a state of increased nociceptive sensitization caused by opioid exposure. The clinical presentation of OIH may resemble tolerance, but the pain of OIH would be aggravated by escalating doses of opioid. Disease progression, exacerbation of preexisting pain and so on should be excluded before diagnosis of OIH. This case report described a buccal cancer patient who suffered from intractable pain, had little analgesic response to high dose morphine. OIH was considered initially, but an organic lesion compatible with pain was noted by image survey months later. Finally, the pain was relieved by palliative radiotherapy. The possible mechanisms, clinical presentations, diagnosis and management of OIH are also introduced briefly.

並列關鍵字

opioid-induced hyperalgesia ； cancer pain ； difficult pain