Zusammenfassung
Hintergrund
Ein hoher Anteil der Tumorpatienten leidet während oder im Anschluss an eine antitumoröse Therapie an mittelstarken bis sehr starken Schmerzen. Durch die Innovationen in der Tumortherapie in den letzten Jahrzenten hat sich die Anzahl insbesondere der Langzeitüberlebenden deutlich erhöht.
Methode
Einbezogen wurden eine selektive Literaturrecherche sowie Erfahrungen aus dem eigenen Patientenkollektiv.
Ergebnisse für die Schmerztherapie
Das Voranschreiten in der Therapie maligner Erkrankungen erfordert eine Angleichung in der Schmerzbehandlung dieser Patienten. Dies beinhaltet die Modifikation und Ergänzung des WHO(World Health Organization)-Stufenschemas, den kritischen Einsatz von Opioiden sowie die Einbindung von medikamentösen, psychosomatischen, interventionellen und physiotherapeutischen Behandlungskonzepten in einen multimodalen Therapieansatz bei Tumorpatienten. Der vorliegende Beitrag diskutiert diese Entwicklung anhand aktueller Literatur und klinischer Erfahrungen der Autoren.
Abstract
Background
A high number of cancer patients suffer from moderate to severe pain during or even after termination of anti-cancer therapy. Due to innovations in cancer therapies over the last decades the number of especially long-term survivors has substantially increased.
Methods
A selective publication search was carried out and experiences from the clinical daily practice are presented.
Results of pain therapy
The progress in the treatment of malignant diseases requires an equivalent development in the treatment of pain in these patients. This includes modifications and adjustments to the World Health Organization (WHO) staging scheme, a critical use of opioids as well as the implementation of medicinal, psychosomatic, interventional and physiotherapeutic treatment concepts in a multimodal therapeutic approach in cancer patients. This article discusses these developments based on the current literature and the authors’ clinical experiences..
Literatur
Arthur JA, Edwards T, Lu Z et al (2016) Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic. Cancer 122:3732–3739
Assouline B, Tramèr MR, Kreienbühl L et al (2016) Benefit and harm of adding ketamine to an opioid in a PCA device for the control of postoperative pain systematic review and meta-analyses of randomised-controlled trials with trial sequential analyses. Pain. https://doi.org/10.1097/j.pain.0000000000000705
Bandschapp O, Filitz J, Urwyler A et al (2011) Tropisetron blocks analgesic action of acetaminophen: a human pain model study. Pain 152:1304–1310
Bluethmann SM, Mariotto AB, Rowland JH (2016) Anticipating the “Silver Tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 25:1029–1036
Bouhassira D, Luporsi E, Krakowski I (2017) Prevalence and incidence of chronic pain with or without neuropathic characteristics in patients with cancer. Pain 158:1118–1125
Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433
Bruera E, Del Fabbro E (2018) Pain management in the era of the Opioid Crisis. Am Soc Clin Oncol Educ Book 38:807–812
Dev R, Parsons HA, Palla S et al (2011) Undocumented alcoholism and its correlation with tobacco and illegal drug use in advanced cancer patients. Cancer 117:4551–4556
Eisenberg E, Marinangeli F, Birkhahm J et al (2005) Time to modify the WHO analgesic leader? Pain Clin Update 13:1–4
Els C, Jackson TD, Kunyk D et al (2017) Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 10:CD12509
Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173
Hamood R, Hamood H, Merhasin I et al (2017) Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-017-4485-0
Hauser W, Bock F, Engeser P et al (2014) Long-term opioid use in non-cancer pain. Dtsch Arztebl Int 111:732–740
Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 274:1870–1873
Kapfhammer HP (2015) Comorbid depressive and anxiety disorders in patients with cancer. Nervenarzt 86:291–292 (294–8, 300–1)
Klepstad P, Loge JH, Borchgrevink PC et al (2002) The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 24:517–525
Kroenke K, Theobald D, Wu J et al (2010) The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manage 40:327–341
Lange H, Kranke P, Steffen P et al (2007) Combined analgesics for postoperative pain therapy. Review of effectivity and side-effects. Anaesthesist 56:1001–1016
Manchikanti L, Kaye AM, Knezevic NN et al (2017) Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician 20:S3–S92
Roos DE (2015) Radiotherapy for neuropathic pain due to bone metastases. Ann Palliat Med 4:220–224
Ruchat D, Suter MR, Rodondi PY et al (2018) Opioid consumption from 1985 to 2015: the situation in Switzerland, with an international comparison. Rev Med Suisse 14:1262–1266
Schneider T, Ruppen W (2017) Opiate – Fluch oder Segen ? – Eine aktuelle Übersicht. Ther Umsch 74:277–283
Shah R, Chou LN, Kuo YF et al (2019) Long-term opioid therapy in older cancer survivors: a retrospective cohort study. J Am Geriatr Soc 67:945–952
Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG et al (2007) High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain 132:312–320
Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56:514–517 (e202–5)
Vowles KE, McEntee ML, Julnes PS et al (2015) Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 156:569–576
Wertli MM, Reich O, Signorell A et al (2017) Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims. BMC Health Serv Res 17:167
Wortzel J, Spiegel D (2017) Hypnosis in cancer care. Am J Clin Hypn 60:4–17
Zech DF, Grond S, Lynch J et al (1995) Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76
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W. Ruppen und T. Schneider geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Ruppen, W., Schneider, T. Moderne Schmerztherapie in der Onkologie. Onkologe 26, 139–143 (2020). https://doi.org/10.1007/s00761-019-00676-7
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DOI: https://doi.org/10.1007/s00761-019-00676-7