The article summarizes the key points of cancer pain treatment

Author: Haixin

This article is published by the author with the authorization of Medical Pulse, please do not reprint it without authorization.

Pain is one of the most common symptoms in cancer patients and can seriously affect the quality of life of cancer patients. The incidence of pain in patients with first-time cancer is about 25%; the incidence of pain in patients with advanced cancer is about 60%-80%, of which 1/3 of patients are severe pain. If the cancer pain is not relieved, the patient will feel extremely uncomfortable, which may cause or aggravate the patient's anxiety, depression, fatigue, insomnia, loss of appetite and other symptoms, which will seriously affect the patient's daily activities, self-care ability, communication ability and overall quality of life.

Cause of cancer pain

Assessment of pain

1

Numerical Grading (NRS)

Mild pain (1-3) Moderate pain (4-6) Severe pain (7-10)

02

Pain Face Scale

03

Complaints Of Pain Level Grading (VRS)

(1) Mild pain: there is pain but it is bearable, life is normal, and sleep is not dry.

(2) Moderate pain: the pain is obvious and unbearable, and it is required to take analgesic drugs and sleep is disturbed.

(3) Severe pain: severe pain, unbearable pain, the need for analgesic drugs, sleep is seriously disturbed, can be accompanied by autonomic disorders or passive position.

Principles of cancer pain treatment

Classification of painkillers

Nonsteroidal drugs

NSAIDs commonly used in the treatment of cancer pain include: ibuprofen, diclofenac, acetaminophen, indomethacin, celecoxib, etc.

Common adverse reactions of NSAIDs are: peptic ulcer, gastrointestinal bleeding, platelet dysfunction, kidney function damage, liver function damage, etc. The occurrence of adverse reactions is related to the dosage and duration of use.

The daily limit for NSAIDs is: ibuprofen 2400 mg/day, acetaminophen 2000 mg/day, celecoxib 400 mg/day.

With the use of nonsteroidal anti-inflammatory drugs, when the dose reaches a certain level or more, increasing the dose does not enhance its analgesic effect, but the toxicity of the drug will increase significantly ("ceiling effect"). Therefore, if long-term use of NSAIDs is required, or when daily doses have reached a limiting dose, consideration should be given to switching to opioid analgesics, or, in combination, only increased doses of opioid analgesics.

Opioids

At present, the short-acting opioids commonly used in the treatment of cancer pain are morphine instant-release tablets, and long-acting opioids are morphine extended-release tablets, oxycodone extended-release tablets, fentanyl transdermal patches, etc.

For the treatment of chronic cancer pain, opioid agonists are recommended.

When long-term maintenance opioid analgesics are used, the oral route of administration is preferred, and subcutaneous injection, intravenous injection, transdermal absorption administration can be used when there is a clear indication, and if necessary, self-controlled analgesic administration can be used.

Opioid dose conversion table

Adjuvant medication in the treatment of cancer pain

04

Side effects of opioids and their treatment

constipation

Nausea, vomiting

Respiratory depression

bibliography

(1) NCCN Guidelines for Cancer Pain in Adults (2021 Edition)

(2) Expert Consensus Opinion on the Norms of External Diagnosis and Treatment of Cancerous Pain in Traditional Chinese Medicine (2014 Edition)

(3) Cancer Pain Diagnosis and Treatment Specification (2011 Edition)

Fei Yong, Yao Ming, Liu Yanqing, et al. Personalized precision treatment of cancer pain[J]. Chinese Medical Journal, 2019, 9(17):1281-1285.

(5) SUN Laibao, LIU Song, CHEN Bingxue. Progress in the treatment of advanced cancer pain[J]. Journal of Practical Pain, 2006(3):186-189.