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谈谈癌性疼痛止痛用药的误区

2018-09-30 药事管理 健康界

疼痛是一种与实际或潜在的组织损伤,或与这种损伤的描述有关的一种令人不愉快的感觉和情感体验,很多疾病都可能给人们带来这种不愉快的疼痛体验,记得以前大学老师说过“疼痛这个不愉快的感觉和体验是一种保护机制”,如果没有疼痛,可能很多人都没有意识到自己生病了,正是疼痛让他们知道自己生病了,提醒他们到医院就诊。

疼痛是一种与实际或潜在的组织损伤,或与这种损伤的描述有关的一种令人不愉快的感觉和情感体验,很多疾病都可能给人们带来这种不愉快的疼痛体验,记得以前大学老师说过“疼痛这个不愉快的感觉和体验是一种保护机制”,如果没有疼痛,可能很多人都没有意识到自己生病了,正是疼痛让他们知道自己生病了,提醒他们到医院就诊。

今天我们想要谈的主题是癌性疼痛,简称癌痛,它是由癌症本身或相关因素引起的疼痛。有研究发现,70%的癌症病人都会出现癌痛,这种疼痛比较剧烈,比癌症本身引起的死亡更为可怕。对于这个说法,我本人十分赞同。曾经我经历过非常剧烈的牙齿痛,冰敷无效、含漱一些止痛的中草药煎液无效、口服1粒芬必得无效,不管是坐着、躺着还是睡着,这种疼痛一点都没有减轻,特别痛苦,情绪随时都会崩溃,甚至会萌生出自杀的念头。可以毫不夸张的说,人在极度疼痛中,是有可能会丧失理智的。本人作为一名药师,本应有更强的用药依从性,但是在那一刻根本顾不了那么多,所以当时我再加服了1粒芬必得,疼痛终于逐渐得以缓解,其实芬必得的用量已经超剂量了,然而在那一刻只要疼痛能得到缓解,别说是芬必得,能够解除痛苦就算是砒霜,我也甘心情愿得用下去了。而癌症的疼痛,它的程度要远远大于牙齿痛,毋庸置疑这些病人是迫切需要使用有效的止痛药。

根据WHO三阶梯原则,第一阶梯主要是非甾体抗炎药,包括对乙酰氨基酚、阿司匹林、布洛芬、吲哚美辛、双氯芬酸钠、塞来昔布、美洛昔康等;第二阶梯主要是弱阿片类药物,包括曲马多、可待因、布桂嗪、氨酚羟考酮、氨酚待因等;第三阶梯主要是强阿片类药物,包括吗啡片、吗啡缓释片、羟考酮缓释片、芬太尼、芬太尼透皮贴等。我国在癌性疼痛止痛用药上存在着一些误区,主要表现在:

误区1:有成瘾性,宁死不用

这是因为我国对于鸦片的成瘾性有着极强的意识,从懂事起就知道了历史上有名的林则徐虎门销烟,这里的烟不是现在人们吸烟的烟草,而是具有成瘾性的大麻、鸦片。也就是说国人从小就知道了阿片是不好的东西,是毒品,具有成瘾性,一旦上瘾了就不可自拔了。因此有些癌症患者或者其家属坚决不用阿片类止痛药物,哪怕面临死亡,也坚决不用。

其实规范的使用阿片类止痛药物,对于癌痛患者的利大于弊,它可以减轻患者的疼痛程度,提高患者的生活质量。只要在医师的指导下合理应用,不乱用、不滥用,它的成瘾性以及不良反应并没有想象中那么可怕。

误区2:横竖都是死,不如快活死

有这样的想法一点也不奇怪。对于很多癌症患者,尤其是晚期的癌症患者而言,他们都知道这是绝症,反正最后的结局都是死亡,与其天天忍受着疼痛,不如天天快活的过,而阿片类药物就具备了这个优点,它既能缓解疼痛,又能让人飘飘然,有欣快感。对于这一类患者,他们会不自禁的要求医生给予用药,频率会越来越频繁,由于耐受性的出现,用药剂量也会越来越大。

庆幸的是,我们国家对于这些具有成瘾性的毒性药品和麻醉性药品的管制非常严格,因此目前我们国家并没有出现像美国那样的滥用。但是目前美国已经意识到了问题的严重性,也开始重视起来了,那么一些生产阿片类止痛药的厂家开始盯上了中国的广阔市场,试图通过多种方式来克服医生的“阿片类药物恐惧症”,鼓励医生开具止痛药物,通过赞助的方式鼓励人们使用止痛药物,消除误区。

会不会走美国的路子?当然不希望出现这样的情况,那么这就需要相关部门制定更多的用药制度和规范,以防阿片类止痛药物的滥用、乱用,成为一些不发分子的生财之道。当然,对于某些止痛药物在国外已经不再使用了,可是还能进入我国的专家指南,这其中的缘由不得而知。针对这个问题,希望国家能够加强对这一类药物进行评估,设置制定专家共识的标准和准入制度,对一些违法犯罪行为进行强有力的打击,还止痛药的一片净土。

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    2019-06-18 cqykthl

    这个有点儿写得。。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=367940, encodeId=4e8836e9403c, content=这个有点儿写得。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Tue Jun 18 08:29:30 CST 2019, time=2019-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348389, encodeId=7d6434838988, content=不够全面啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Sun Oct 07 17:54:43 CST 2018, time=2018-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308851, encodeId=8dda130885131, content=<a href='/topic/show?id=aa7291842d9' target=_blank style='color:#2F92EE;'>#误区#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91842, encryptionId=aa7291842d9, topicName=误区)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Tue Oct 02 00:18:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405552, encodeId=8f271405552cf, content=<a href='/topic/show?id=597b631634d' target=_blank style='color:#2F92EE;'>#止痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63163, encryptionId=597b631634d, topicName=止痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8da42553722, createdName=zhangxingru, createdTime=Tue Oct 02 00:18:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
    2018-10-07 cqykthl

    不够全面啊

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=367940, encodeId=4e8836e9403c, content=这个有点儿写得。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Tue Jun 18 08:29:30 CST 2019, time=2019-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348389, encodeId=7d6434838988, content=不够全面啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Sun Oct 07 17:54:43 CST 2018, time=2018-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308851, encodeId=8dda130885131, content=<a href='/topic/show?id=aa7291842d9' target=_blank style='color:#2F92EE;'>#误区#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91842, encryptionId=aa7291842d9, topicName=误区)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Tue Oct 02 00:18:00 CST 2018, time=2018-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405552, encodeId=8f271405552cf, content=<a href='/topic/show?id=597b631634d' target=_blank style='color:#2F92EE;'>#止痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63163, encryptionId=597b631634d, topicName=止痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8da42553722, createdName=zhangxingru, createdTime=Tue Oct 02 00:18:00 CST 2018, time=2018-10-02, status=1, ipAttribution=)]
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