Zusammenfassung.
Eine ausreichende Therapie der Schmerzen hat für Tumorpatienten höchste Priorität.
WHO-Richtlinien schlagen eine - in der deutschsprachigen Literatur obligate - Kombination
von Opioiden mit Nichtopioid-Analgetika (NOA) für Patienten mit mittleren bis starken
Schmerzen vor. Tumorschmerzen können durch den Tumor selbst verursacht, tumorassoziiert,
therapiebedingt sowie therapieunabhängig sein, und nur durch eine Kombinationstherapie
von Opioiden mit NOA, wie den Cyclooxygenase-Inhibitoren (nicht-steroidalen Antirheumatika
= NSAR) beherrscht werden. Eine Kombination von Opioiden mit Nichtopioidanalgetika
bringt, unter Wahrung von Vorsichtsmaßnahmen, eine bessere Effizienz bei akzeptablem
Risikoprofil.
Non-opioid-analgesics - irreplaceable in cancer pain therapy?
Sufficient therapy of pain is essential for the treatment of tumor patients. World
Health Organisation (WHO)-guidelines recommend a combination of opioids with non-opioid-analgesics
(NOA) for patients with medium to strong pain. Cancer pain is often a combination
of pain caused by the tumor itself, tumor associated and pain caused by therapy. Various
substances act by different mechanisms and therefore combinations may demonstrate
superior effects. Opioids („central analgesics”) inhibit neuronal transduction within
the spinal cord, enhance inhibiting function of midbrain nuclei on ascending pain
transduction and influence pain perception via modulation of the limbic system. NOAs
(„peripheral analgesics”) inhibit cyclooxygenase hindering activation of the peripheral
nociceptorsystem. There are 2 different classes of NOAs: 1) non-acidic, antipyretic
analgesics like pyrazolones (metamizol) and anilin-derivates (paracetamol) and 2)
non-steroidal antirheumatics (NSAR) like salicylates (acetylsalicylic acid), derivates
of propionic acid (ibuprofen, naproxen), acetate acid (indomethacin, diclofenac),
enolic acid (piroxicam, meloxicam) and anthranil acid (mefenamin). Adjuvant therapy
is necessary to control common NSAR-side-effects like dyspepsia, ulcer and gastrointestinal
bleeding. Due to its exceptional analgesic, antipyretic and spasmolytic properties,
metamizol is an essential substance in tumor therapy. As agranulocytosis-incidence
of 1:1.000.000 is low, good gastrointestinal and renal tolerance makes metamizol an
excellent alternative to NSAR. There is scientific evidence that adequate combinations
of non-opioids, opioids and adjuvant drugs, considering adverse side effects, were
effective and safe in the treatment of cancer pain.
Schlüsselwörter:
Tumor-Schmerz - Nicht-opioid-Analgetika - Opioide
Key words:
Tumor pain - Non-opioid-analgesics - Opioids - Metamizol
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