印度疼痛研究学会(ISSP)癌症疼痛特别兴趣小组(SIG)关于成人癌症疼痛的药理学管理的指南提供了一个结构化的,逐步的方法,这将有助于改善癌症疼痛的管理,并为患者提供最低可接受的生活质量。该指南是根据现有文献和证据制定的,为了满足需求,患者群体,以及印度的情况。一份问卷,根据每个分草案的关键要素,这些要素涉及缺乏证据的某些不确定的领域,在ISSP网站上提供,并通过电子邮件分发给所有ISSP和印度姑息治疗协会成员。我们建议用于癌症疼痛管理的镇痛药应遵循世界卫生组织针对疼痛严重程度的3步镇痛阶梯。对于轻度至中度疼痛,应单独使用对乙酰氨基酚和非甾体类抗炎药或与阿片类药物联合使用。对于轻度至中度疼痛,弱阿片类药物如曲马多,他他他多,可待因可与非阿片类镇痛药联合使用。我们建议吗啡作为中度至重度癌症疼痛的首选阿片类药物。缓释制剂可以开始12小时,一旦确定了立即释放吗啡的有效24小时剂量。如果镇痛不足或不能耐受的副作用,应考虑阿片类药物的转换或旋转。对于阿片类药物引起的呼吸抑制,必须迅速使用μ受体拮抗剂(例如纳洛酮)。抗抑郁药和/或抗惊厥药应用于治疗神经性癌症疼痛,剂量应根据临床反应和副作用进行滴定。应向所有患有疼痛性转移性骨痛的患者提供外部束放射治疗。有证据表明氯胺酮用于癌症神经性疼痛,但是没有有益的效果,因此,不推荐。
The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group (SIG) guidelines on pharmacological management of cancer pain in adults provide a structured, stepwise approach, which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire, based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website and circulated by e-mail to all the ISSP and Indian Association of Palliative Care members. We recommend that analgesics for cancer pain management should follow the World Health Organization 3-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of the first choice for moderate-to-severe cancer pain. Sustained-release formulations can be started 12 hourly, once the effective 24 h dose with immediate-release morphine is established. Opioid switch or rotation should be considered if there is inadequate analgesia or intolerable side effects. For opioid-induced respiratory depression, μ receptor antagonists (e.g. naloxone) must be used promptly. Antidepressants and/or anticonvulsants should be used to treat neuropathic cancer pain, and the dose should be titrated according to the clinical response and side effects. External beam radiotherapy should be offered to all patients with painful metastatic bone pain. There is evidence on use of ketamine in cancer neuropathic pain, but with no beneficial effect, thus, it is not recommended.