癌症相关神经病理性疼痛临床管理中国专家共识

doi:10.3760/cma.j.cn371439-20260118-00043

摘要/Abstract

摘要：

癌症相关神经病理性疼痛（CRNP）是癌症患者常见的疼痛类型，严重影响患者的生命质量。为规范CRNP的临床管理，中国临床肿瘤学会肿瘤支持与康复治疗专家委员会组织相关领域专家，基于GRADE证据分级系统，制定了本共识。共识明确了CRNP的定义与病因分类（癌症引发、抗癌治疗引发、癌症共病引发），系统阐述了CRNP的筛查、诊断与评估流程，推荐使用DN4、LANSS等量表进行筛查，并依据NeuPSIG分级系统进行确诊。治疗方面，推荐根据病因选择钙离子通道调节剂、三环类抗抑郁药、5-羟色胺-去甲肾上腺素再摄取抑制剂等一线药物，并强调联合治疗、局部治疗、微创介入及物理治疗等多模式干预。同时，应重视患者教育、心理支持、传统医学及长期随访管理。本共识为CRNP的个体化、多学科综合管理提供了循证依据和实践指导。

关键词: 癌性疼痛, 神经痛, 诊断, 治疗, 专家共识

Abstract:

Cancer-related neuropathic pain （CRNP） is a common type of pain among cancer patients， significantly impacting their quality of life. To standardize the clinical management of CRNP， the Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee organized experts from related fields to develop this consensus based on the GRADE evidence grading system. The consensus clarifies the definition and etiological classification of CRNP （cancer-induced， anticancer treatment-induced， and oncology multimorbidity-related）， systematically elaborates on the screening， diagnosis， and assessment processes of CRNP， recommends the use of scales such as DN4 and LANSS for screening， and confirms the diagnosis based on the NeuPSIG grading system. In terms of treatment， the consensus recommends selecting first-line drugs such as calcium channel modulators， tricyclic antidepressants， and serotonin-norepinephrine reuptake inhibitors based on the etiology， and emphasizes multimodal interventions such as combination therapy， local therapy， minimally invasive intervention， and physical therapy. Additionally， priority should be given to comprehensive patient education， evidence-informed psychological support， integration of traditional medicine and structured long-term follow-up management. This consensus provides evidence-based basis and practical guidance for the individualized and multidisciplinary comprehensive management of CRNP.

Key words: Cancer pain, Neuralgia, Diagnosis, Therapy, Expert consensus

中国临床肿瘤学会肿瘤支持与康复治疗专家委员会. 癌症相关神经病理性疼痛临床管理中国专家共识[J]. 国际肿瘤学杂志, 2026, 53(5): 257-267.

Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee. Chinese expert consensus on the clinical management of cancer-related neuropathic pain[J]. Journal of International Oncology, 2026, 53(5): 257-267.

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证据等级	定义
高质量（A）	进一步研究几乎不可能改变对临床疗效评估结果的可信度
中等质量（B）	进一步研究可能对疗效评估结果的可信度有重要影响
低质量（C）	进一步研究很有可能对疗效评估结果的可信度有重要影响，且极有可能改变评估结果
极低质量（D）	任何疗效评估结果都不确定

推荐级别	定义
强推荐	基于可获得证据，非常确定获益大于风险和负担
弱推荐	基于可获得证据，认为获益、风险和负担相当平衡，或获益、风险的程度存在明显不确定性

感觉异常	体征	描述
阳性体征	自发性疼痛	没有任何外部刺激就出现的疼痛（异常性疼痛）
	痛觉过敏	对正常致痛刺激引起的疼痛感增强（如针刺、冷热刺激）
	痛觉超敏	正常情况下不产生疼痛的刺激引起的疼痛（如触摸、移动、冷热刺激等）
对正常刺激的疼痛敏感性增强	感觉异常	自发或诱发的不愉快的异常感觉（如电击样）
	感觉麻木	自发或诱发的并非不愉快的异常感觉（如麻刺感、蜂鸣样、振动感）
阴性体征	感觉减退	对刺激产生的感觉减退，不包括特殊感觉
	感觉缺失	总体感觉缺失（尤其触觉敏感性）
	痛觉减退	正常情况下导致疼痛的刺激产生的疼痛降低
	痛觉缺失	对正常情况下导致疼痛的刺激无反应

评估类目	评估项目	评估内容/工具
疼痛相关	疼痛部位
	疼痛程度	认知和交流能力良好患者：视觉模拟评分量表（VAS）、数字分级评分量表（NRS）、语言分级评分量表（VRS）认知或交流能力较差患者：面部表情评分量表（FPS）
	疼痛性质	DN4量表；询问疼痛为持续性的或间歇性的，是否伴有间歇性加重
	疼痛持续时间	记录疼痛开始和持续的时间
	触发或缓解因素
	神经系统检查	评估有无痛觉过敏、异常疼痛、感觉减退等症状，并确定功能异常的分布区域
	影像学、神经电生理检查	（可选）根据患者情况
生命质量		简明疼痛评估量表（BPI）、简化麦吉尔疼痛问卷（SF-MPQ）
心理状态		患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑自评量表（GAD-7）

药物类别	药物名称	国内获批适应证	癌症引发的NeP	CIPN	放疗后NeP	肿瘤切除术后NeP
钙离子通道调节剂	加巴喷丁	癫痫、带状疱疹后神经痛	B^[22-23]（弱推荐）	B^[38]（弱推荐）	B^[43]（强推荐）	C^[49]（弱推荐）
	普瑞巴林	带状疱疹后神经痛、纤维肌痛、癫痫、糖尿病周围神经痛	A^[23-24]（强推荐）	A^[36]（强推荐）	A^[43-45]（强推荐）	A^[45]（强推荐）
	美洛加巴林	糖尿病周围神经痛	B^[26]（弱推荐）	B^[40]（强推荐）		B^[48]（弱推荐）
	克利加巴林	糖尿病周围神经痛、带状疱疹后神经痛				B^[52]（弱推荐）
三环类抗抑郁药	阿米替林	抑郁症、儿童多尿症、儿童多动症	B^[30]（弱推荐）	B^[41]（弱推荐）
5-羟色胺-去甲肾上腺素再摄取抑制剂	度洛西汀	抑郁症、广泛性焦虑障碍、慢性肌肉骨骼疼痛	B^[31]（强推荐）	A^[34-35]（强推荐）