赖桂花　袁晶　闫钰婷　程雄涛　曹建雄

〔摘要〕 骨转移癌痛是由晚期恶性肿瘤转移到骨引起的顽固性疼痛，痛势剧烈，严重影响癌症患者生活质量，其治疗成为临床研究的重点。西医治疗以三阶梯止痛药物治疗为主，疗效肯定且显效迅速，但是患者长期大剂量服用会产生多种毒副反应，而中医治疗能够缓解西医治疗带来的毒副反应，提高患者机体免疫力且有一定的止痛、抗肿瘤作用，临床上与西医联合使用则可以优势互补，达到增效减毒、痛瘤同治的目的。本文对近年来骨转移癌痛的中西医治疗进行综述，以期为今后临床诊疗提供有益参考。

〔关键词〕 骨转移癌痛;中医药;西医;中西医结合

〔中图分类号〕R2;R730       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.09.025

Advances of the Treatment of Bone Metastatic Cancer Pain by Traditional

Chinese and Western Medicine

LAI Guihua， YUAN Jing， YAN Yuting， CHENG Xiongtao， CAO Jianxiong*

（The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China）

〔Abstract〕 Bone metastatic cancer pain is an intractable pain caused by the metastasis of advanced malignant tumors to bones. The pain is severe and affects the quality of life of cancer patients. Its treatment has become the focus of clinical research. The bone metastatic cancer pain is mainly treated with three-step analgesic drugs. The curative effect is positive and rapid， but long-term high-dose administration will produce a variety of toxic and side effects. Traditional Chinese medicine treatment of bone metastatic cancer pain can alleviate the toxic and side effects caused by Western medicine treatment， improve the patient's immunity and have certain analgesic and anti-tumor effects. Clinically， traditional Chinese medicine and Western medicine combined use can complement each other's advantages， to achieve the purpose of synergism， pain and tumor treatment. This paper reviewed the treatment of bone metastatic cancer pain by Chinese and Western medicine in recent years in order to provide useful reference for future clinical diagnosis and treatment.

〔Keywords〕 bone metastatic cancer pain; traditional Chinese medicine; Western medicine; integrative Chinese and western medicine

根據WHO统计，全球每天至少有500万以上的癌症患者受到疼痛的折磨，其中有25%患者初诊时出现疼痛，晚期癌症患者的疼痛发生率可高达60%～90%，其中1/3的患者为重度疼痛，骨转移癌痛是癌痛中最为剧烈和难以控制的疼痛，也是一种临床常见的顽固性疼痛，常见于乳腺癌、前列腺癌、肺癌等[1-2]。现代医学治疗主要是病因治疗与对症治疗，对症治疗以止痛药物为主，止痛效果明确，但长期使用存在一定的不良反应[3-4]。近年来中医药治疗骨转移癌痛广泛应用于临床，包括辨证论治、专方专药、外治法、针灸及配合西医多种治疗方法，临床上应用取得满意疗效。

1 骨转移癌痛机制

1.1  西医机制

1.1.1  骨组织的变化  正常骨代谢通过成骨细胞的成……