癌性疼痛的处理

癌性疼痛的处理WHO 3-阶梯镇痛疗法Management of Cancer PainWHO 3 Step Analgesic Ladder,Terence L. Gutgsell, MDHospice of the BluegrassLexington, 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ObjectivesCompare, contrast nociceptive, neuropathic painKnow steps of analgesic management of cancer painKnow alternative routes for delivery of opioid analgesicsDemonstrate ability to convert between opioids while maintaining analgesia,躯体的疼痛PhysicalPain,情感的疼痛EmotionalPain,社交障碍Social Discord,宗教的困扰SpiritualDistress,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 PrinciplesInfluences on patients 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 pathophysiologyAcute pain Identified event, resolves daysweeks Usually nociceptiveChronic 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 painDirect stimulation of intact nociceptorsTransmission along normal nervesSharp, aching, throbbing Somatic- Easy to describe, localize Visceral- Difficult to describe, localize,感受伤害性疼痛组织损伤明显治疗 阿片类药物 辅助药物/联合镇痛剂N