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Moderne Schmerztherapie in der Onkologie

  • Wilhelm RuppenEmail author
  • Tobias Schneider
Leitthema
  • 34 Downloads

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.

Schlüsselwörter

Tumorschmerz Multimodaler Therapieansatz Opioide WHO-Stufenschema Langzeitüberlebende 

Modern pain treatment in oncology

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..

Keywords

Cancer pain Multimodal therapeutic approach Opioids WHO staging scheme Long-term survivors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

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.

Literatur

  1. 1.
    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 122:3732–3739CrossRefGoogle Scholar
  2. 2.
    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 CrossRefPubMedGoogle Scholar
  3. 3.
    Bandschapp O, Filitz J, Urwyler A et al (2011) Tropisetron blocks analgesic action of acetaminophen: a human pain model study. Pain 152:1304–1310CrossRefGoogle Scholar
  4. 4.
    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 25:1029–1036CrossRefGoogle Scholar
  5. 5.
    Bouhassira D, Luporsi E, Krakowski I (2017) Prevalence and incidence of chronic pain with or without neuropathic characteristics in patients with cancer. Pain 158:1118–1125CrossRefGoogle Scholar
  6. 6.
    Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433CrossRefGoogle Scholar
  7. 7.
    Bruera E, Del Fabbro E (2018) Pain management in the era of the Opioid Crisis. Am Soc Clin Oncol Educ Book 38:807–812CrossRefGoogle Scholar
  8. 8.
    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 117:4551–4556CrossRefGoogle Scholar
  9. 9.
    Eisenberg E, Marinangeli F, Birkhahm J et al (2005) Time to modify the WHO analgesic leader? Pain Clin Update 13:1–4Google Scholar
  10. 10.
    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:CD12509PubMedGoogle Scholar
  11. 11.
    Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173CrossRefGoogle Scholar
  12. 12.
    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 CrossRefPubMedGoogle Scholar
  13. 13.
    Hauser W, Bock F, Engeser P et al (2014) Long-term opioid use in non-cancer pain. Dtsch Arztebl Int 111:732–740PubMedPubMedCentralGoogle Scholar
  14. 14.
    Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 274:1870–1873CrossRefGoogle Scholar
  15. 15.
    Kapfhammer HP (2015) Comorbid depressive and anxiety disorders in patients with cancer. Nervenarzt 86:291–292 (294–8, 300–1)CrossRefGoogle Scholar
  16. 16.
    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 24:517–525CrossRefGoogle Scholar
  17. 17.
    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 40:327–341CrossRefGoogle Scholar
  18. 18.
    Lange H, Kranke P, Steffen P et al (2007) Combined analgesics for postoperative pain therapy. Review of effectivity and side-effects. Anaesthesist 56:1001–1016CrossRefGoogle Scholar
  19. 19.
    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–S92PubMedGoogle Scholar
  20. 20.
    Roos DE (2015) Radiotherapy for neuropathic pain due to bone metastases. Ann Palliat Med 4:220–224PubMedGoogle Scholar
  21. 21.
    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 14:1262–1266PubMedGoogle Scholar
  22. 22.
    Schneider T, Ruppen W (2017) Opiate – Fluch oder Segen ? – Eine aktuelle Übersicht. Ther Umsch 74:277–283CrossRefGoogle Scholar
  23. 23.
    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 67:945–952CrossRefGoogle Scholar
  24. 24.
    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 363:733–742CrossRefGoogle Scholar
  25. 25.
    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 132:312–320CrossRefGoogle Scholar
  26. 26.
    Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56:514–517 (e202–5)PubMedPubMedCentralGoogle Scholar
  27. 27.
    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 156:569–576CrossRefGoogle Scholar
  28. 28.
    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 17:167CrossRefGoogle Scholar
  29. 29.
    Wortzel J, Spiegel D (2017) Hypnosis in cancer care. Am J Clin Hypn 60:4–17CrossRefGoogle Scholar
  30. 30.
    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 63:65–76CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department AnästhesieUniversitätsspital BaselBaselSchweiz

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