Abstract: Background　Moderate and severe cancer pain has become one of the reasons for the decline in the quality of life of cancer patients.Although strong opioids represented by morphine are effective for it, there are 40% to 60% of patients still cannot adequately control their cancer pain, and the way in which transcutaneous electrical nerve stimulation（TENS） assists drugs in the treatment of cancer pain has been gradually recognized by scholars. Objective　To explore the effect of TENS on the efficacy and safety of opioid analgesic insufficiency in bone metastatic cancer pain. Methods　A total of 48 patients with bone metastatic cancer pain in Jiangnan Hospital Affiliated to Zhejiang Chinese Medicine University and Zhejiang Cancer Hospital from September 2017 to May 2018 were selected and then divided into the opioid group（24 cases） who treated with opioid only and the combined treatment group（24 cases） who treated with TENS combined with opioid according to the random number table method.The pain was assessed by Brief Pain Inventory; the 24-hour equivalent morphine dosage, the number of breakthrough pain and adverse drug reactions for 24 hours were recorded before treatment, 2 weeks and 4 weeks after treatment.The differences between the two groups were compared. Results　The most severe pain, average pain and current pain scores after 2 weeks and 4 weeks of treatment in the combined treatment group were lower than those in the opioid group（P<0.05） . The most severe pain and average pain after 2 weeks and 4 weeks of treatment in the two groups were significantly lower than those before treatment in the same group（P<0.05）．The equivalent morphine dosage after 2 weeks and 4 weeks of treatment was higher than that before treatment in two groups（P<0.05） , and the dosage of the combined treatment group was significantly lower than that of the opioid group in the same period（P<0.05） ．The number of breakthrough pain episodes after 2 weeks and 4 weeks of treatment in two groups was less than that before treatment（P<0.05） , and the reduction was more obvious in the combined treatment group than that in the opioid group （P<0.05）．During the treatment period, the adverse reactions of opioids in the two groups mainly included nausea, vomiting, constipation, dizziness, and pruritus, without any adverse reactions such as drowsiness and respiratory depression. The incidence of nausea, vomiting and constipation in the combined treatment group was lower than that in the opioid group（P<0.05） ．Conclusion　Combined with opioid therapy, TENS can effectively alleviate bone metastatic cancer pain, slow down opioid dosage process in patients with cancer pain, and reduce the incidence of adverse reactions, with relatively higher efficacy and safety.

Key words: Carcinoma, Transcutaneous electrical nerve stimulation, Analgesia, Opioids, Bone metastatic cancer pain, Treatment outcome

摘要： 背景　中重度癌痛已成为癌症患者生存质量下降的原因之一，尽管以吗啡为代表的强阿片类药物对中重度癌痛效果明显，但仍有40%~60%的癌痛患者得不到充分控制。而经皮神经电刺激疗法（TENS）辅助药物治疗癌痛的方式已逐渐被学者认可。目的　探讨TENS对阿片类药物镇痛不全的骨转移癌痛有效性和安全性的影响。方法　选取2017年9月—2018年5月在浙江中医药大学附属江南医院和浙江省肿瘤医院住院治疗的骨转移癌痛患者48例，按随机数字表法将其分为阿片类药物组（24例）和联合治疗组（24例），分别采用单纯阿片类药物和TENS联合阿片类药物治疗。治疗前、治疗2周、4周后采用简明疼痛评估量表评估疼痛程度，记录24 h等效吗啡用量、24 h暴发痛发作次数及药物不良反应，比较两组间的差异。结果　联合治疗组治疗2周、4周后最剧烈疼痛、平均疼痛、目前疼痛评分低于阿片类药物组（P<0.05）；两组治疗2周、4周后最剧烈疼痛、平均疼痛、目前疼痛评分低于同组治疗前（P<0.05）。两组治疗2周、4周后等效吗啡用量高于同组治疗前（P<0.05）；且同期组间比较，联合治疗组等效吗啡用量低于阿片类药物组（P<0.05）。两组治疗2周、4周后暴发痛发作次数少于同组治疗前（P<0.05）；且同期组间比较，联合治疗组暴发痛发作次数少于阿片类药物组（P<0.05）。两组患者在治疗期间阿片类药物不良反应主要包括恶心呕吐、便秘、头晕、瘙痒等，没有出现嗜睡、呼吸抑制等不良反应。联合治疗组恶心呕吐、便秘发生率低于阿片类药物组（P<0.05）。结论　TENS联合阿片类药物治疗能有效减轻骨转移癌痛，并可减缓癌痛患者阿片类药物用量进程，同时降低不良反应发生率，有效性和安全性相对更高。

关键词: 癌, 经皮神经电刺激, 镇痛, 阿片类药物, 骨转移癌痛, 治疗结果