关注老年癌症止痛

虽然肿瘤的发病率在老年人并不低，但社会对老年人的关注度并不高。几乎所有肿瘤药物临床试验都把老年人排除在外，因此，不少药品说明书特别注明“缺乏老年人资料”。老年癌痛治疗领域也存在同样的问题。老年癌痛的病理生理及心理特点很独特，加之对老年癌病重视不够及缺乏正确评价，所以老年癌痛的研究相当复杂，因而癌痛的处理犹如癌症一样也需要综合治疗。癌痛治疗药物可分成两大类：非阿片类及阿片类药物。非阿片类药物中首选对乙酰氨基酚治疗轻度癌痛，非甾体类抗炎药，特别是选择性COX2抑制剂可在对乙酰氨基酚无效时应用。阿片类药物则广泛应用于中度到重度的癌痛治疗。辅助治疗药物包括三环抗抑郁药、抗惊厥药、苯二氮蕈类药物等。可用于癌痛三阶梯治疗的任一阶段，能够治疗特殊类型疼痛，改善癌痛以外的症状，增加主要药物镇痛效果，减轻副作用，但不推荐常规使用。总而言之，对于老年癌症患者更要强调以镇痛为主的姑息治疗，特别在重症老年患者，可能成为最重要的治疗，有时甚至是唯一有效妁治疗。

Odynolysis in Elder Patients with Cancer

Despite of the increasing incidence rate of cancer in elder patients, the emphasis on it isn＇t quite enough. Almost every clinical trial for cancer rules out patients older than 75 years and many indications of drugs show only a sentence at the end： “Lack of data in elder people”! Same situation exists in the field of treatment of cancer pain in elder patients. Cancer pain in elder patients is very unique and complicated due to the facts of the specific physiological and emotional backgrounds of elder people, the insufficient odynolysis and lacking of correct evaluation. Considering of the complications presented clinically and etiologically, combined therapy should also be recommended in treatment of cancer pain, as well as in cancer therapy. There are two families of drugs used in the odynolysis of elder cancer patients： non-opioids and opioids. Among the first family, paracetamol should be the first choice for minor pain and nonsteroid anti-inflammatory drugs （NSAIDs）, especially the selective COX2 inhibitors, can be considered when paracetamol is not capable of controlling the pain. Opioids are widely used for moderate to severe cancer pain. Adjuvant drugs, including tricyclic antidepressants, anticonvulsants and benzodiazepines, are also helpful and can be used in every “ladder” of pain, but they are not recommended as a routine. In summary, much more effort should be assigned to the palliative treatment （mostly the odynoly- sis） of elder patients with cancer and it might be the most, sometimes the only, effective way to improve the quality of life for those who are seriously sick from cancer.