目的 分析“拈痛散”膏灸联合三阶梯止痛法治疗晚期胃癌患者癌性疼痛的疗效及对癌因性疲乏的影响。 方法 选取青岛市中医医院2023年1月至2025年6月收治的152例晚期胃癌癌痛且存在癌因性疲乏的患者，随机分为对照组与联合组，各76例。对照组予以三阶梯止痛法，联合组予以三阶梯止痛法联合“拈痛散”膏灸治疗，连续治疗4周后评价疗效。观察两组患者的癌痛疗效、数字分级法（NRS）评分、简明疼痛评估量表（BPI）评分、Piper疲乏修订量表（PFS-R）评分、疼痛介质［5-羟色胺（5-HT）、P物质（SP）、神经肽Y（NP-Y）、前列腺素E2（PGE2）］及不良反应。 结果 治疗后，联合组的癌痛有效率较对照组更高（P < 0.05）；联合组的NRS评分、BPI-疼痛程度评分、BPI-疼痛干扰评分、PFS-R评分均低于对照组（P < 0.05），血清SP、5-HT、NP-Y、PGE2水平也均低于对照组（P < 0.05）。两组不良反应发生率接近（P > 0.05）。 结论 “拈痛散”膏灸联合三阶梯止痛法治疗晚期胃癌癌痛的疗效显著，可逆转疼痛因子失衡，缓解癌因性疲乏。

Objective To analyze the efficacy of Niantong powder plaster moxibustion combined with the three-step analgesic ladder in the treatment of cancer pain in patients with advanced gastric cancer and its influence on cancer-related fatigue. Methods A total of 152 patients with advanced gastric cancer， cancer pain， and cancer-related fatigue， who were admitted to Qingdao Traditional Chinese Medicine Hospital from January 2023 to June 2025， were selected and randomly divided into a control group and a combined group， with 76 cases in each group. The control group was treated with the three-step analgesic ladder， whereas the combined group received treatment with the three-step analgesic ladder combined with Niantong powder plaster moxibustion. The efficacy was evaluated after 4 weeks of continuous treatment. In the two groups of patients， the efficacy of cancer pain， scores of the numerical rating scale （NRS）， brief pain inventory （BPI）， and revised Piper fatigue scale （PFS-R）， pain mediators ［5-hydroxytryptamine （5-HT）， substance P （SP）， neuropeptide Y （NP-Y）， prostaglandin E2 （PGE2）］， and adverse reactions were observed. Results After treatment， the cancer pain relief rate in the combined group was significantly higher than that in the control group （P < 0.05）. The combined group had lower NRS scores， BPI-pain severity scores， BPI-pain interference scores， and PFS-R scores compared to the control group （P < 0.05）. Additionally， it also presented lower serum levels of SP， 5-HT， NP-Y， and PGE2 （P < 0.05）. The incidence of adverse reactions was comparable between the two groups （P > 0.05）. Conclusions Niantong powder plaster moxibustion， when combined with the three- step analgesic ladder， demonstrates significant efficacy in treating advanced gastric cancer accompanied by cancer pain. Moreover， it can reverse the imbalance of pain factors and alleviate cancer-related fatigue.