实验和观察研究表明，阿片类镇痛药可能会增加肿瘤生长，可能降低免疫治疗疗效并缩短生存期。由于缺乏临床数据，目前持续阿片类镇痛治疗的基本原理是基于动物模型，这表明身体疼痛本身可能会影响癌症的生长并发挥免疫抑制作用。总体疼痛涵盖患者在癌症治疗过程中可能经历的各种因素：身体症状、社会孤立/孤独、心理、精神/存在和经济困难。这些需要进行筛查并与患者讨论，以帮助他们应对治疗和疾病。由于每个问题都可能影响生存，因此必须识别它们以了解它们如何影响患者的免疫系统、影响免疫治疗结果并最终影响生存。问题是，单一因素（例如阿片类药物和免疫检查点抑制剂的组合）是否会对治疗结果产生负面影响。虽然存在促进阿片类药物恐惧症的风险，但必须考虑总疼痛、生活质量和免疫系统之间复杂的相互作用。因此，在适当调查阿片类镇痛药与免疫系统之间相互作用的研究中，必须考虑患者在疾病的每个阶段可能经历的所有痛苦因素。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

Experimental and observational studies have shown that opioid analgesics may increase tumor growth, potentially reduce immunotherapy efficacy, and shorten survival. As a result of the lack of clinical data, the current rationale for continuing opioid analgesic treatment is based on animal models, which suggests that physical pain itself may potentially influence cancer growth and exert immunosuppressive effects. Total pain encompasses the various factors that patients may experience during their cancer journey: physical symptoms, social isolation/loneliness, psychological, spiritual/existential, and financial distress. These need to be screened and discussed with patients to help them cope with the treatment and disease. As each issue may affect survival, it is essential to identify them to understand how they might affect the patient's immune system, influence immunotherapy outcomes, and ultimately, survival. The question arises whether a single factor, such as the combination of opioids and immune checkpoint inhibitors, negatively affects treatment outcomes. While there is a risk of fostering opioid phobia, the complex interplay between total pain, quality of life, and the immune system must be considered. Thus, in studies that appropriately investigate the interactions between opioid analgesics and the immune system, it is essential to consider all the distress factors that patients may experience at each stage of their illness.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.