文档介绍：癌性疼痛的处理 WHO 3-阶梯镇痛疗法 Management of Cancer Pain WHO 3 – Step Analgesic Ladder
Terence L. Gutgsell, MD
Hospice of the Bluegrass
Lexington, KY
目标
比较,对比感受伤害性的和神经病性的疼痛
了解癌痛镇痛处理的阶梯
了解阿片类镇痛剂给药的其他途径
讲解维持镇痛时阿片类药物间互相转换的技巧
pare, contrast nociceptive, neuropathic pain
Know steps of analgesic management of cancer pain
Know alternative routes for delivery of opioid analgesics
Demonstrate ability to convert between opioids while
maintaining analgesia
躯体的疼痛Physical
Pain
情感的
疼痛
Emotional
Pain
社交
障碍
Social
Discord
宗教的困扰Spiritual
Distress
病痛=总体的疼痛
Suffering = Total Pain
总的原则
多因素对患者反应的影响
环境心理/社会状态年龄
性别多系统疾病和障碍复合用药
General Principles
Influences on patient’s response to Rx
Environment
Psycho/social status
Age
Sex
Multi-system disease and disorders
Polypharmacy
普遍原则
“拇指原则”
诊断可能的机制,个体化治疗
ATC和PRN用药,保持简单
反复评价,注意细节
General Principles
“Rules of Thumb”
Diagnose underlying mechanism
Individualize treatment
ATC and PRN medications
Keep it simple, Reassess
Attention to Detail
疼痛的病理生理学
急性疼痛
已明确的原因,缓解时间:数日到数周
通常是感受伤害性的
慢性疼痛
原因常不易确定,多因素的
持续时间不确定
感受伤害性的和/或神经病理性的
Pain pathophysiology
Acute pain
Identified event, resolves days–weeks
Usually nociceptive
Chronic pain
Cause often not easily identified, multifactorial
Indeterminate duration
Nociceptive and / or neuropathic
感受伤害性的疼痛
对健全的伤害感受器的直接刺激
沿正常神经传递
锐痛,酸痛,搏动性疼痛
本体性的
-易于描述和定位
内脏性的
-难以描述和定位
Nociceptive pain
Direct stimulation of intact nociceptors
Transmission along normal nerves
Sharp, aching, throbbing
Somatic
- Easy to describe, localize
Visceral
- Difficult to describe, localize
神经病性疼痛
外周或中枢神经的功能障碍
压迫,横断,浸润,缺血,代谢性损伤
不同类型
外周的
传入神经阻滞
交感神经介导的
Neuropathic pain
Disordered peripheral or central pression, transection, infiltration, ischemia, metabolic injury
Varied types
Peripheral
deafferentation
sympathetically mediated
神经病性疼痛
疼痛可能不仅只由可见的损伤引起
描述为烧灼感,麻刺感,射痛,刺痛,电击样疼痛
治疗
阿片类药物
常需要辅助药物/联合镇痛剂
Neuropathic pain
Pain may exceed observable injury
Described as burning, tingling, shooting, stabbing, el