Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite stable and adequately controlled background pain). They found a paucity of placebo-controlled trials for background cancer pain, although tapentadol or codeine may be more efficacious than placebo (moderate-certainty to low-certainty evidence). Nonsteroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac, ketorolac, and the antidepressant medicine imipramine, may be at least as efficacious as opioids for moderate-to-severe background cancer pain. For breakthrough cancer pain, oral transmucosal, buccal, sublingual, or intranasal fentanyl preparations were identified as more efficacious than placebo but were more commonly associated with toxicities, including constipation and nausea. Despite being recommended worldwide for the treatment of cancer pain, morphine was generally not superior to other opioids, nor did it have a more favorable toxicity profile. The interpretation of study results, however, was complicated by the heterogeneity in the study populations evaluated. Given the limited quality and quantity of research, there is a need to reappraise the clinical utility of opioids in people with cancer pain, particularly those who are not at the end of life, and to further explore the effects of opioids on immune system function and quality of life in these individuals.

中文翻译：

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阿片类镇痛药治疗伤害性癌痛：全面综述


疼痛是癌症患者最痛苦的症状之一，阿片类镇痛药被认为是癌症疼痛治疗的支柱。在这篇综述中，作者评估了阿片类镇痛药与安慰剂、其他阿片类镇痛药、非阿片类镇痛药和非药物治疗相比对背景癌痛（静息时持续且相对持续的疼痛）和突破性癌痛（短暂加剧）的疗效和毒性。尽管背景疼痛稳定且得到充分控制，但仍感到疼痛）。他们发现，尽管他喷他多或可待因可能比安慰剂更有效（中等质量至低质量证据），但针对背景癌症疼痛的安慰剂对照试验却很少。非甾体类抗炎药，包括阿司匹林、吡罗昔康、双氯芬酸、酮咯酸和抗抑郁药丙咪嗪，对于中度至重度癌症疼痛可能至少与阿片类药物一样有效。对于突破性癌症疼痛，口腔粘膜、口腔、舌下或鼻内芬太尼制剂被认为比安慰剂更有效，但更常见与毒性有关，包括便秘和恶心。尽管吗啡被全世界推荐用于治疗癌症疼痛，但它通常并不优于其他阿片类药物，也没有更有利的毒性特征。然而，由于所评估的研究人群的异质性，研究结果的解释变得复杂。鉴于研究质量和数量有限，有必要重新评估阿片类药物在癌症疼痛患者（尤其是尚未临终患者）中的临床效用，并进一步探讨阿片类药物对免疫系统功能和癌症疼痛的影响。这些人的生活质量。