癌症疼痛控制的現況

Current Status of Cancer Pain Management

10.6537/TJHPC.2012.17(1).5

李雅萍(Ya-Ping Lee)；黃馨葆(Sin-Bao Huang)；蔡兆勳(Jaw-Shiun Tsai)；陳慶餘(Ching-Yu Chen)；邱泰源(Tai-Yuan Chiu)

癌症疼痛處置 ； 疼痛評估 ； 藥物治療 ； 非藥物治療 ； cancer pain management ； pain assessment ； pharmacological therapy ； non-pharmacological therapy

安寧療護雜誌

17卷1期（2012 / 03 / 01）

62 - 75

繁體中文

疼痛仍是影響癌症病人生活品質的重要因素。改善疼痛是提升癌症病人照護品質的重要工作。做好癌症疼痛處置的首要步驟在於周全性的疼痛評估，才能達到以病人為中心的疼痛控制。從1986年世界衛生組織（WHO）發表第一版癌症疼痛指引（Cancer pain relief）開始，二十多年來癌症疼痛控制的發展一日千里。WHO指引的最重要一環是有效使用口服鴉片類藥物緩解中重度疼痛。鑑於大眾對於鴉片類藥物仍存有疑慮，1996年European Association of Palliative Care（EAPC）以WHO指引為基礎，對於鴉片類藥物的使用做出二十項建議，並於2001年更新內容，建議口服嗎啡是緩解中度至重度癌症疼痛的首選藥物。2012年European Palliative Care Research Collaborative（EPCRC）發表具實證基礎的鴉片類藥物使用指引。適切的癌症疼痛控制，除了正確的疼痛評估及藥物使用外，非藥物處置也是相當重要的。本文除了討論癌症疼痛藥物控制的發展，同時強調周全性疼痛評估與非藥物治療的相關證據。

Pain is an important factor affecting the quality of life of cancer patients. Thus, pain relief is an important issue to promote the quality of cancer patient care. In order to achieve appropriate patient-centered pain control, to do a comprehensive pain assessment is most important. There have been rapid advances in cancer pain management since the first edition of cancer pain relief from the World Health Organization (WHO) was published in 1986. The most important issue of the WHO guideline is the efficient use of oral opioids for moderate to severe pain. The European Association for Palliative Care (EAPC) research network proposed 20 recommendations on the use of morphine and alternative opioids in cancer pain in 1996, and had an update in 2001. European Palliative Care Research Collaborative (EPCRC) further published an evidence-based guideline on the use of opioid analgesics in the treatment of cancer pain in 2012. In addition to pain assessment and pharmacological therapy, non-pharmacological strategies are very important in cancer pain management. Therefore, we discuss not only the pharmacological advances in cancer pain control, but also the evidence of comprehensive pain assessment and non-pharmacological pain management.

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