癌症爆发痛的现状及进展
Current Research and Advances in Cancer Breakthrough Pain
DOI: 10.12677/ACM.2019.93039, PDF,    科研立项经费支持
作者: 邵 岚, 张沂平：浙江省肿瘤医院胸部肿瘤内科，浙江 杭州
关键词: 癌症；爆发痛；治疗；Cancer； Breakthrough Pain； Treatment
摘要: 癌症爆发痛(breakthrough cancer pain, BTcP)是指相对稳定的慢性背景疼痛的癌症患者经历短暂的疼痛加重。典型的BTcP的常见临床特征主要是发作迅速，强度大，持续时间短。癌症爆发痛影响患者的生活质量，加重医疗负担。首先，有效的评估是关键。即释阿片类药物是目前BTcP的主要治疗药物。黏膜型芬太尼因起效迅速、生物利用度高、作用方便等特点，在癌症爆发痛的治疗上具有优势。本文主要从BTcP的定义、分类、病理机制、评估、管理及治疗方面进展进行综述。
Abstract: Cancer patients with relatively stable chronic background pain may experience transient episodes of pain, known as breakthrough cancer pain (BTcP). Common clinical features of a typical BTP ep-isode include a rapid onset peaking within minutes, a severe intensity and a short duration. BTcP affects patients’ quality of life and increases pressure on healthcare systems. Firstly, effective as-sessment is critical. Immediate-release opioids are the mainstay of treatment for BTcP. Mucosal fentanyl has advantages in the treatment of BTcP due to its rapid effect, high bioavailability and convenience. This review presents the latest research advances on the definition, classification, pathological mechanism, evaluation, management and characteristics of different treatment methods of cancer breakthrough pain.
文章引用：邵岚, 张沂平. 癌症爆发痛的现状及进展[J]. 临床医学进展, 2019, 9(3): 257-267. https://doi.org/10.12677/ACM.2019.93039

参考文献

[1] van den Beuken-van Everdingen, M.H., Hochstenbach, L.M., Joosten, E.A., Tjan-Heijnen, V.C. and Janssen, D.J. (2016) Update on Prevalence of Pain in Patients with Cancer: Systematic Review and Meta-Analysis. Journal of Pain and Symptom Management, 51, 1070-1090 e1079. [Google Scholar] [CrossRef] [PubMed]
[2] 中华人民共和国卫生部. 癌症疼痛诊疗规范(2011 年版) [S]. 北京: 中华人民共和国卫生部, 2012.
[3] 廖小卒, 李彬飞, 程周. 癌症疼痛的治疗进展[J]. 医学信息, 2010, 23(8): 3051-3053.
[4] Davies, A., Buchanan, A., Zeppetella, G., et al. (2013) Breakthrough Cancer Pain: An Observational Study of 1000 European Oncology Patients. Journal of Pain and Symptom Management, 46, 619-628. [Google Scholar] [CrossRef] [PubMed]
[5] Deandrea, S., Corli, O., Consonni, D., Villani, W., Greco, M.T. and Apolone, G. (2014) Prevalence of Breakthrough Cancer Pain: A Systematic Review and a Pooled Analysis of Published Literature. Journal of Pain and Symptom Management, 47, 57-76. [Google Scholar] [CrossRef] [PubMed]
[6] Greco, M.T., Corli, O., Montanari, M., et al. (2011) Ep-idemiology and Pattern of Care of Breakthrough Cancer Pain in a Longitudinal Sample of Cancer Patients: Results from the Cancer Pain Outcome Research Study Group. Clinical Journal of Pain, 27, 9-18. [Google Scholar] [CrossRef] 
[7] Portenoy, R.K. and Hagen, N.A. (1990) Breakthrough Pain: Definition, Prevalence and Characteristics. Pain, 41, 273-281. [Google Scholar] [CrossRef] 
[8] Davies, A.N., Dickman, A., Reid, C., et al. (2009) The Management of Cancer-Related Breakthrough Pain: Recommendations of a Task Group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. European Journal of Pain, 13, 331-338. [Google Scholar] [CrossRef] [PubMed]
[9] Mercadante, S. and Cuomo, A. (2016) Breakthrough Cancer Pain: Ten Commandments. Value Health, 19, 531-536. [Google Scholar] [CrossRef] [PubMed]
[10] NCCN (2018) Adult Cancer Pain. Version I.
[11] Davies, A., Zeppetella, G., Andersen, S., et al. (2011) Multi-Centre European Study of Breakthrough Cancer Pain: Pain Character-istics and Patient Perceptions of Current and Potential Management Strategies. European Journal of Pain, 15, 756-763. [Google Scholar] [CrossRef] [PubMed]
[12] Zeppetella, G. (2011) Breakthrough Pain in Cancer Patients. Clinical Oncology (Royal College of Radiologists (Great Britain)), 23, 393-398. [Google Scholar] [CrossRef] [PubMed]
[13] Esparza-Minana, J.M. (2018) Diagnosis and Medical Treatment of Breakthrough Pain. Medicina Clínica (Barc), 150, 114-118. [Google Scholar] [CrossRef] 
[14] Cervero, F., Meyer, R.A. and Campbell, J.N. (1994) A Psy-chophysical Study of Secondary Hyperalgesia: Evidence for Increased Pain to Input from Nociceptors. Pain, 58, 21-28. [Google Scholar] [CrossRef] [PubMed]
[15] Zeppetella, G., O’Doherty, C.A. and Collins, S. (2001) Prev-alence and Characteristics of Breakthrough Pain in Patients with Non-Malignant Terminal Disease Admitted to a Hospice. Palliative Medicine, 15, 243-246. [Google Scholar] [CrossRef] [PubMed]
[16] Chou, R., Fanciullo, G.J., Fine, P.G., et al. (2009) Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. The Journal of Pain, 10, 113-130. [Google Scholar] [CrossRef] [PubMed]
[17] Caraceni, A., Hanks, G., Kaasa, S., et al. (2012) Use of Opioid Analgesics in the Treatment of Cancer Pain: Evidence-Based Recommendations from the EAPC. The Lancet Oncology, 13, e58-e68. [Google Scholar] [CrossRef] 
[18] Hagen, N.A., Stiles, C., Nekolaichuk, C., et al. (2008) The Alberta Breakthrough Pain Assessment Tool for Cancer Patients: A Validation Study Using a Delphi Process and Patient Think—Aloud Interviews. Journal of Pain and Symptom Management, 35, 136-152. [Google Scholar] [CrossRef] [PubMed]
[19] Webber, K., Davies, A.N., Zeppetella, G. and Cowie, M.R. (2014) Development and Validation of the Breakthrough Pain Assessment Tool (BAT) in Cancer Patients. Journal of Pain and Symptom Management, 48, 619-631. [Google Scholar] [CrossRef] [PubMed]
[20] Lossignol, D.A. and Dumitrescu, C. (2010) Breakthrough Pain: Progress in Management. Current Opinion in Oncology, 22, 302-306. [Google Scholar] [CrossRef] 
[21] Schug, S.A. and Ting, S. (2017) Fentanyl Formulations in the Management of Pain: An Update. Drugs, 77, 747-763. [Google Scholar] [CrossRef] [PubMed]
[22] Farrar, J.T., Cleary, J., Rauck, R., Busch, M. and Nordbrock, E. (1998) Oral Transmucosal Fentanyl Citrate: Randomized, Double-Blinded, Placebo-Controlled Trial for Treatment of Breakthrough Pain in Cancer Patients. Journal of the National Cancer Institute, 90, 611-616. [Google Scholar] [CrossRef] [PubMed]
[23] Christie, J.M., Simmonds, M., Patt, R., et al. (1998) Dose-Titration, Multicenter Study of Oral Transmucosal Fentanyl Citrate for the Treatment of Breakthrough Pain in Cancer Patients Using Transdermal Fentanyl for Persistent Pain. Journal of Clinical Oncology, 16, 3238-3245. [Google Scholar] [CrossRef] 
[24] Blick, S.K. and Wagstaff, A.J. (2006) Fentanyl Buccal Tablet: In Breakthrough Pain in Opioid-Tolerant Patients with Cancer. Drugs, 66, 2387-2393.
[25] Weinstein, S.M., Messina, J. and Xie, F. (2009) Fentanyl Buccal Tablet for the Treatment of Breakthrough Pain in Opioid-Tolerant Patients with Chronic Cancer Pain: A Long-Term, Open-Label Safety Study. Cancer, 115, 2571-2579. [Google Scholar] [CrossRef] [PubMed]
[26] Mercadante, S. (2012) Pharmacotherapy for Breakthrough Cancer Pain. Drugs, 72, 181-190. [Google Scholar] [CrossRef] [PubMed]
[27] Lennernas, B., Frank-Lissbrant, I., Lennernas, H., Kalkner, K.M., Derrick, R. and Howell, J. (2010) Sublingual Administration of Fentanyl to Cancer Patients Is an Ef-fective Treatment for Breakthrough Pain: Results from a Randomized Phase II Study. Palliative Medicine, 24, 286-293. [Google Scholar] [CrossRef] [PubMed]
[28] Nalamachu, S.R., Narayana, A. and Janka, L. (2011) Long-Term Dosing, Safety, and Tolerability of Fentanyl Buccal Tablet in the Management of Noncancer-Related Breakthrough Pain in Opioid-Tolerant Patients. Current Medical Research and Opinion, 27, 751-760. [Google Scholar] [CrossRef] [PubMed]
[29] Vasisht, N., Gever, L.N., Tagarro, I. and Finn, A.L. (2010) Single-Dose Pharmacokinetics of Fentanyl Buccal Soluble Film. Pain Medicine, 11, 1017-1023. [Google Scholar] [CrossRef] [PubMed]
[30] 马培奇. 爆发性癌痛治疗新药枸橼酸芬太尼鼻喷雾剂Instanyl [J]. 上海医药, 2010, 31(11): 525-526.
[31] Thronaes, M., Popper, L., Eeg, M., Jaatun, E., Kvitberg, M. and Kaasa, S. (2015) Efficacy and Tolerability of Intranasal Fentanyl Spray in Cancer Patients with Breakthrough Pain. Clinical Therapeutics, 37, 585-596. [Google Scholar] [CrossRef] [PubMed]
[32] Watts, P. and Smith, A. (2009) PecSys: In Situ Gelling System for Optimised Nasal Drug Delivery. Expert Opinion on Drug Delivery, 6, 543-552. [Google Scholar] [CrossRef] [PubMed]
[33] Mercadante, S., Radbruch, L., Davies, A., et al. (2009) A Comparison of Intranasal Fentanyl Spray with Oral Transmucosal Fentanyl Citrate for the Treatment of Breakthrough Cancer Pain: An Open-Label, Randomised, Crossover Trial. Current Medical Research and Opinion, 25, 2805-2815. [Google Scholar] [CrossRef] [PubMed]
[34] Li, Y.X., Han, W.J., Tang, H.T., et al. (2013) Nitrous Ox-ide-Oxygen Mixture during Burn Wound Dressing: A Double-Blind Randomized Controlled Study. CNS Neuroscience & Therapeutics, 19, 278-279. [Google Scholar] [CrossRef] [PubMed]
[35] Liu, Q., Gao, L.L., Dai, Y.L., et al. (2018) Nitrous Oxide/Oxygen Mixture for Analgesia in Adult Cancer Patients with Breakthrough Pain: A Randomized, Double-Blind Controlled Trial. The Journal of Pain, 22, 492-500. [Google Scholar] [CrossRef] [PubMed]

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