中医结合三阶梯止痛法综合治疗癌性疼痛的临床研究  

Clinical Research Progress of TCM combined with Three-Step Analgesic Therapy for Cancer Pain

作　　者：田琳[1] 李戈[2] 王佛有 TIAN Lin;LI Ge;WANG Foyou(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;Dalian Hospital of Traditional Chinese Medicine,Dlian 116033,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]大连市中医医院肿瘤科,辽宁大连116033

出　　处：《实用中医内科杂志》2020年第1期68-71,共4页Journal of Practical Traditional Chinese Internal Medicine

基　　金：大连市科技局项目(2017RQ078)。

摘　　要：癌痛是恶性肿瘤最常见的并发症之一,可由肿瘤本身导致癌痛,也可因肿瘤压迫周围组织、神经等产生疼痛,或在治疗过程中产生。癌痛按时间可以分为急性痛和慢性痛,按病理学特征可分为伤害感受性疼痛和神经病理性疼痛,或二者混合。长期癌痛直接影响肿瘤患者的生理与心理状态,严重降低患者生存期生活质量,甚至瓦解治疗信心和对治疗方案的依从性,从而影响治疗效果,缩短生存周期。目前,西医控制癌痛以WHO三阶段止痛方案、抗肿瘤治疗、非药物疗法等为主,其中以WHO三阶梯止痛方案为基本策略,具有普遍性、有效性、经济性等特点,但止痛药物在治疗同时不可忽略期不良反应及非阿片类药物的“封顶作用”,制约了三阶梯止痛法的应用效果。祖国医学认为“本虚标实”“正虚邪实”是恶性肿瘤的基本病机,症状有以实痛为主,也有以虚痛为主,常采取辨病与辨证相结合,扶正与驱邪并举的方式,既重视由癌毒,又兼顾正虚,常以中药汤剂、膏剂、针刺、艾灸、穴位埋线等联合WHO三阶梯止痛方案联合应用,体现中医整体观念、个体化治疗的优势,鼓励多学科合作,可有效减少西药不良反应,延缓阶梯用药上升进程,减少突破痛发生几率,提升患者生活质量,以接近控制癌痛的最佳效果和最小代价,中医抗癌止痛思路可作为三阶梯止痛法的重要补充。Cancer pain is one of the most common complications of malignant tumors.It can be caused by the tumors themselves,by the tumors pressing the surrounding tissues and nerves,or in the course of treatment.Cancer pain can be divided into acute pain and chronic pain according to time.According to pathological characteristics,it can be divided into nociceptive pain and neuropathic pain,or a mixture of them.Long-term cancer pain directly affects the physiological and psychological status of cancer patients,seriously reduces the quality of life of patients,and even disrupts the confidence of treatment and compliance with treatment options,and thus affecting the treatment effect and shortening the life cycle.At present,the three-stage analgesic regimen,anti-cancer therapy and non-drug therapy are the main methods to control cancer pain in western medicine.Among them,the three-step analgesic regimen of WHO is the basic strategy,which has the characteristics of universality,effectiveness and economy.However,the adverse reactions of analgesics in the treatment of cancer can not be neglected and the"capping"of non-opioids can not be ignored.The application effect of the three-step analgesic method is restricted.Traditional Chinese medicine holds that the basic pathogenesis of malignant tumors is"deficiency of origin and excess of substance"and"deficiency and excess of pathogen".Cancer pain is the mostly accompanied.There are both excessive pain and deficiency pain.The combination of disease differentiation and differentiation of symptoms and signs is often adopted.Both cancer toxicity and deficiency of substance are emphasized,and traditional Chinese medicine decoction is often used.The application of three-step analgesic schemes of WHO combined withprescriptions,plaster,acupuncture,moxibustion and catgut embedding at acupoints,embodies the advantages of the overall concept of traditional Chinese medicine and individualized treatment,encourages multi-disciplinary cooperation.It can effectively reduce adverse reactions of West

关 键 词：癌性疼痛 中医治疗 中西医结合 三阶梯止痛法 临床治疗 

分 类 号：R589.2[医药卫生—内分泌]