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1、CancerPainSyndromesCraigD.Blinderman,MD,MACo-Director,MGHCancerPainClinicMGHPalliativeCareServiceObjectivesReviewthedefinitionofpainandbasicpathophysiologyReviewthecommoncausesofpainincancerpatientsReviewapproachtomanagingpainDefiningPainPainisdefinedasanunpleasants
2、ensoryandemotionalexperienceassociatedwithactualorpotentialtissuedamage,ordescribedintermsofsuchdamage.Merskey,H.,Bogduk,N,ed.ClassificationofChronicPain,SecondEdition.IASPTaskForceonTaxonomy.1994,IASPPress:Seattle.209-214.TaxonomyofPainClassificationmaybebasedon:An
3、atomyBodySystemTemporalCharacteristicsSeverityEtiologyPathophysiologyDefinedpainsyndromesTaxonomyofPainClinically,itisusefultodetermineboththeetiologyandinferredpathophysiologyintheassessmentofthepaincomplaint,asthismaysuggesttheuseofspecifictherapies.TaxonomyofPain
4、NociceptiveSomaticVisceralNeuropathicPsychogenicIdiopathicNociceptivePainNociceptivesomaticpainSustainedpredominantlybytissueinjuryorinflammation.Describedassharp,aching,stabbing,throbbingorpressure-like.NociceptivevisceralpainPoorlylocalized;describedascrampypain(e
5、.g.obstructionofhollowviscus),orasachingandstabbing(e.g.painsecondarytosplenomegaly).NeuropathicPainSustainedbyabnormalsomatosensoryprocessinginthePNSorCNS.Typically,describedas“burning,”“shock-like,”“electrical.”Maybeparoxysmalinnature.Onphysicalexamination,patient
6、smayhaveallodynia(paininducedbynon-painfulstimuli)andhyperalgesia(increasedperceptionofpainfulstimuli).PsychogenicPainReferstopainthatisbelievedtobesustainedpredominantlybypsychologicalfactors.Rareinthecancerpopulation.IdiopathicPainIntheabsenceofevidencesufficientt
7、olabelpainaseithernociceptiveorneuropathic,wemayusetheterm“idiopathic.”Inpatientswithcancer,thistermshouldleadtoadditionalworkupandasearchforanunderlyingetiologyandpathophysiology.BasicPathophysiologyofPainTransductionConversionofthermal,chemical,mechanicalstimulust
8、oelectricalactivityatnociceptorNachannelsConductionPassageofactionpotentialalongthefirstorderneurontodorsalhornofspinalcordTransmissionTra