The most common symptom in cancer patients is cancerous pain. According to incomplete statistics, 70% of cancer patients have pain at different stages of the disease course. Relieving pain can not only alleviate the mental and physical torture of the patient, improve the quality of life, but also help to control the condition and further **, and ultimately prolong the survival of the patient. However, if the medication for pain is not standardized, it will cause patients to have adverse reactions and even have the opposite effect. So, how can cancer pain patients cooperate with doctors to better manage their pain and achieve a good quality of life?
1. What is the "three ladders" of cancer pain**?
In the early 90s of the 20th century, the World Health Organization (WHO) proposed a "three-tiered ladder**" of cancer pain, which was gradually widely accepted around the world. Practice has proved that standardized medication can make the vast majority of patients get rid of cancer pain. Depending on the severity of pain, NSAIDs (Tier 1), weak opioids (Tier 2), and strong opioids (Tier 3) are used alone or in combination, increasing gradually from weak to strong. Generally, the first ladder is started, and only when the previous ladder of the standard is invalid, the next ladder is started. Depending on the condition, a second or third step can also be used directly for pain relief. First-tier analgesics can be used in combination with second-tier and third-tier analgesics, respectively.
1. First-step analgesics: mainly for mild cancer pain, especially for patients with bone metastases. Representative drugs include aspirin, ibuprofen and voltarin. Aspirin can be used, 25 to 60 mg each time; or paracetamol, 025～0.5 grams; or painkiller tablets, 1 to 2 tablets each time. In addition, ibuprofen (Fenpidex), propoxyphen tablets, etc. are also available.
2. Second-tier analgesics: mainly for moderate cancer pain, and the representative drugs include tramadol, codeine and strong pain. Codeine can be used, 30 to 60 mg each time; or aminophen codeine tablets, 1 tablet each time; or strong pain, 30 90 mg each time; or tramadol extended-release tablets, 50 to 100 mg each time. In addition, pain relievers such as propoxyphen tablets can also be used.
3. Three-step painkillers: mainly for severe cancer pain, and general painkillers are difficult to work. Representative drugs include morphine tablets or injections, OxyContin (i.e., morphine extended-release tablets), or OxyContin (i.e., oxycodone hydrochloride extended-release tablets); If it cannot be taken orally, it can be administered by **. Fentanyl can also be used.
2. What is the WHO three-step principle of pain relief?
1. Oral administration. Oral and non-invasive routes are preferred. Oral medication, non-invasive, convenient, safe and economical. With the progress of research on new dosage forms of painkillers, in addition to oral route administration, other non-invasive routes of administration are becoming more and more widely used, such as transdermal patch for pain relief**. If the patient has dysphagia, severe vomiting or gastrointestinal obstruction, transdermal patches and rectal suppositories can be used. Continuous subcutaneous infusion using an infusion pump if necessary.
2. Dose according to the ladder. This is the WHO-recommended regimen for cancer pain**. i.e., use of non-opioids and adjunctive drugs for mild pain; weak opioids, non-opioids, and adjunctive medications for moderate pain; For severe pain, strong opioids, non-opioids, and adjunctive medications are used.
3. Administer the drug on time. It means that analgesics should be administered regularly at prescribed intervals. When using analgesics, the dose that controls the patient's pain must be measured first, and the next dose should be given before the previous drug wears off, so that the pain can be relieved continuously. Some patients have sudden, severe pain that can be given as needed.
4. Individualization of medication. Due to individual differences, there is no ideal standard dosage of opioids, and the dose that can relieve pain is the correct dose, so the choice of opioids should start with a small dose and gradually increase to the dose that provides ideal pain relief and no significant non-response.
5. Pay attention to specific details. Patients using analgesics should be monitored, closely observed the degree of pain relief, and necessary measures should be taken in time to reduce the adverse reactions of drugs as much as possible and improve the analgesic effect.
3. What should I pay attention to when using painkillers?
1. Don't panic when you have pain for the first time. It is often assumed that the presence of pain is a sign that the tumor is at an advanced stage. In fact, there are many reasons for pain in cancer patients, such as nerve damage after surgery, some chemotherapy drugs and radiotherapy***, etc., which may cause pain. When pain first occurs, patients need to be aware of the timing of the pain, its severity, and the pattern of change. Watch for this and talk to your doctor about it during your appointment.
2. Go to the specialist for treatment, and do not rush to the doctor. Only a trained doctor is able to perform pain**, and not every doctor can give a professional advice on pain management. Therefore, patients are advised to bring all medical records to a specialist. If you rush to the doctor, it is possible that the pain will not be well controlled, but there will be a lot of unnecessary *** leading to difficulties in the future.
3. Give painkillers in a timely manner. In the past, it was thought that patients with cancer pain should be given pain relief before they died**. However, many cancer patients actually develop pain at an earlier age, and this pain is often unbearable. Therefore, for cancer patients with pain, various ** measures should be taken decisively so that the patient can alleviate the pain both mentally and physically. Pain can cause the patient's general condition to deteriorate rapidly, and if it is not eliminated in time, it is also very detrimental to the cancer.
4. Do not use Demerol. Demerol (meperidine) is a synthetic opioid receptor agonist, and the analgesic effect is only 1 10 of morphine, and the pain relief time can only last 2 to 4 hours. The drug is metabolized in vivo as norpiperidine, which has central neurotoxic and nephrotoxic effects. Cancer patients who use this drug in large doses will inevitably cause accumulation, poisoning, tremors, hallucinations, convulsions, muscle spasms and seizures. In addition, after the injection of Demerol, the concentration in the blood and subsequent in the brain rises rapidly, and it is easy to produce euphoria.
5. Take medication according to the doctor's instructions. Surveys have shown that 80% of cancerous pain in 90% of cases can be well controlled with medication. At present, morphine and related drugs are commonly used and effective pain relievers. When it comes to morphine, some patients are reluctant to use it because they immediately think of drugs, fear of addiction and discomfort after stopping the drug. The doctor's decision on how much medication to take is based on the patient's pain level. In the process of medication, patients should not increase or decrease the drug at will, otherwise unexpected consequences may occur.
6. Don't worry about "addiction". Many people worry about "addiction" from opioid use, but this is not the case. Clinical studies have found that opioids generally do not become "addictive" when used in a standardized manner. The reason is that in the process of pain traveling along the nerve pathway in the body, special opioid receptors are generated, and these receptors "neutralize" the drug entering the body, avoiding the feeling of "floating" due to the activation of opioid receptors in the brain; However, because there is no painful stimulus in normal people, the opioid receptors in the brain are directly stimulated after application, resulting in "addiction".
7. Long-term medication, timely treatment of side effects. Most cancer pain lasts for a long time, so it is also a long-term process. Therefore, be patient, otherwise stopping the drug too soon will not produce actual pain relief. For the first time taking morphine drugs, some patients will have side effects such as nausea, vomiting, dizziness, and drowsiness, which will gradually disappear after 3 to 7 days of medication. About 1 to 3 patients will experience constipation. Therefore, patients should drink plenty of water, eat plenty of vegetables, and take the medicine prescribed by the doctor to prevent constipation. In addition, opioids may suppress breathing. If the number of breaths is found to be less than 8 minutes, the patient should be pinched immediately to make him feel pain, and sent to the hospital for diagnosis and treatment in time.
8. Appropriate activities to maintain a good mood. Different patients with cancer pain have different physical exercises and daily activities. For example, if you have breast cancer, one arm is swollen and painful after surgery, and if you can climb the wall and comb your hair for a long time, the pain may be relieved. In addition, patients are too preoccupied with the condition, which can lead to worsening pain. It is recommended that patients distract themselves from the disease, read books, listen to **, or chat with family members, etc., think more about happy things, and try to maintain a happy mood, which is of great help to the recovery of the disease and pain control.