癌痛治疗指南解析

对多国成人癌痛指南进行检索、回顾，发现近年癌痛治疗领域新进展和各国普遍遵循的共同原则，为临床医生改进癌痛治疗提供参考。采用现有的互联网临床实践指南检索平台，对成人癌痛指南进行检索，分析各国指南的异同之处，重点对疼痛评估、WHO三阶梯药物治疗及辅助治疗进行比较、归纳。全面的癌痛评估是指痛治疗的必要前提，也是众多癌痛指南强调的重点；按疼痛程度选择三阶梯镇痛药物仍是药物止痛的基本原则；口服途径是止痛治疗的首选给药途径；第一阶梯药物中阿司匹林的应用逐渐淡化，NSAIDs的毒性反应受到关注；第二阶梯药物的选择更灵活。应根据疼痛性质、患者的具体情况合理选择复合制荆。吗啡仍是强阿片类药物中的首选，可用于中、重度疼痛的治疗。因此，我国成人癌痛治疗需要改进，应重点推广全面的疼痛评估，提倡根据患者的具体情况合理、灵活的选择三阶梯药物，个体化治疗是止痛治疗的关键。

Interpretation of Treatment Guideline on Cancer Pain

To find recent developments and consensus in adult cancer pain therapy around the world and improve adult cancer pain therapy in China. Different practice guidelines on adult cancer pain were searched with the platform currently available on the internet and were compared mainly on pain evaluation, analgesics of WHO three-step ladders and coanalgesics of pain therapy. Comprehensive pain evaluation prior to pain therapy is extremely important. It＇s also the key point which many guidelines strengthened. Prescribe analgesics according to pain intensity is still the basic principle in pain therapy; Aspirin attend to be less prescribed and the toxicity of NSAIDs is widely concerned; the selection of the second-step anal-gesics seems to be more flexible. Different compounds should be chosen according to patient＇s pain quality and individual conditions. Morphine is still the first choice among strong opioids and it can be used in controlling moderate to severe cancer pain. Adult cancer pain therapy needs to be improved in our country. Pain evaluation should be advocated. Selecting suitable analgesics individually is the key point in pain control.