世界卫生组织针对癌性疼痛的三阶梯止痛方案遵循哪些核心原则?
What core principles does the WHO three-step analgesic ladder follow for cancer pain?
按疼痛强度分阶梯选药,并贯彻五项基本原则。轻度痛首选非甾体抗炎药等非阿片类;中度痛加用可待因等弱阿片类;重度痛改用吗啡等强阿片类,必要时联用辅助镇痛药。原则为口服给药、按阶梯用药、按时给药、个体化滴定剂量与注意细节观察,维持血药浓度平稳,使镇痛充分且副作用可控,目标是夜间安睡、静息无痛、活动基本不受限。
Analgesics are chosen by pain intensity on the ladder under five ground rules. Mild pain starts with non-opioids such as NSAIDs; moderate pain adds weak opioids like codeine; severe pain moves to strong opioids such as morphine, with adjuvant analgesics as needed. The principles are oral administration, by-the-ladder selection, around-the-clock timing, individualized dose titration, and attention to detail - steady drug levels deliver adequate analgesia with manageable side effects, aiming for undisturbed sleep, painless rest, and largely unrestricted activity.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
世界卫生组织专著《Cancer Pain Relief》,WHO日内瓦1986年
World Health Organization, Cancer Pain Relief, WHO Geneva, 1986
#癌痛 #三阶梯止痛 #阿片类药物
加巴喷丁和普瑞巴林最初作为抗癫痫药研发,为什么对带状疱疹后神经痛这类神经病理性疼痛同样有效?
Gabapentin and pregabalin were first developed as antiseizure agents, so why do they also relieve neuropathic pain conditions such as postherpetic neuralgia?
两类药物的共同靶点是神经元上电压门控钙通道的α2δ亚基。药物与之结合后钙内流减少,脊髓背角释放的谷氨酸和P物质等兴奋性递质随之下降,痛觉信号向中枢的传递被削弱。带状疱疹后神经痛以受损神经异常放电和中枢敏化为特征,这种突触前抑制恰好切断其放大环节;普瑞巴林还能改善睡眠与焦虑,间接提高疼痛耐受阈值。
Both agents share the alpha-2-delta subunit of neuronal voltage-gated calcium channels as their target. Binding reduces calcium influx, which lowers release of excitatory transmitters such as glutamate and substance P from the spinal dorsal horn and weakens nociceptive traffic toward the brain. Postherpetic neuralgia is defined by ectopic firing in damaged nerves and central sensitization, and this presynaptic inhibition interrupts exactly that amplification loop; pregabalin also improves sleep and anxiety, indirectly raising pain tolerance.
难度 进阶 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-11-03
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Brunton LL主编专著《Goodman & Gilman's The Pharmacological Basis of Therapeutics》第13版,McGraw-Hill
Goodman & Gilman's The Pharmacological Basis of Therapeutics, 13th edition, edited by Laurence L. Brunton, McGraw-Hill
独立核验依据 · Independent verification: 核验依据 1 OPENLIBRARY 标识 /works/OL18376456W：Goodman & Gilman's the
#神经病理性疼痛 #加巴喷丁类 #钙通道α2δ亚基
没有抑郁症的患者服用地洛西汀后神经病理性疼痛也会减轻,这是为什么?
Why does duloxetine relieve neuropathic pain even in patients who are not depressed?
因为镇痛来自增强下行抑制通路,与改善情绪无关。地洛西汀等5-羟色胺和去甲肾上腺素再摄取抑制剂使延髓中缝核与蓝斑核投向脊髓背角的递质增多,经突触前α2受体等抑制初级传入末梢释放谷氨酸和P物质,平息背角神经元敏化;阿米替林还附加阻断钠通道。故疗效不依赖情绪改变,指南将其列为神经病理性疼痛的一线口服药。
Because their analgesia comes from boosting descending inhibition rather than lifting mood. As serotonin-norepinephrine reuptake inhibitors, duloxetine raises 5-HT and norepinephrine in pathways from the raphe nuclei and locus coeruleus to the dorsal horn, where alpha-2 receptor activation curbs release of glutamate and substance P from primary afferents and calms sensitized horn neurons; amitriptyline additionally blocks sodium channels. The benefit is independent of mood status, so guidelines rank these drugs among first-line oral agents.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 已核验 · Verified 2026-10-04
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专著《Wall and Melzack's Textbook of Pain》第6版,McMahon SB与Koltzenburg M主编,Elsevier 2013年
Wall and Melzack's Textbook of Pain, 6th edition, edited by S.B. McMahon and M. Koltzenburg, Elsevier, 2013
独立核验依据 · Independent verification: 核验依据 1 ISBN 9780702040597 (2013)
#地洛西汀 #下行抑制通路 #神经病理性疼痛