What is cancer pain?
Cancer pain is a very common symptom in cancer patients and refers to pain caused by tumors. This pain is usually caused by the tumor's infiltration or compression of surrounding tissues and nerves. The presentation and intensity of cancer pain can vary greatly depending on the location, size, and spread of the tumor. Cancer pain can be broadly divided into the following three categories:
Tumor-related pain: This is the most immediate type of pain and usually occurs when the tumor directly invades or compresses a part of the body. For example, a tumor may invade bones, organs, or nerves, causing persistent or paroxysmal pain. Metastatic cancers, such as those that have metastasized to the bone, can cause severe pain.
Antineoplastic therapy-related pain: This pain is associated with treatments for cancer, including surgery, radiation therapy, chemotherapy, and other medical procedures. For example, surgery may affect the structure and function of the body, leaving postoperative pain, radiation therapy may cause radiation burns or tissue damage, and chemotherapy may cause neuralgia or other types of pain.
Non-neoplastic cause pain: This pain may be caused by other pathological conditions in cancer patients, such as infection, inflammation, or musculoskeletal pain due to prolonged bed rest. This type of pain can be directly related to the tumor, but it can also be related to a decline in overall health.
Why is cancer pain so important?
The importance of cancer pain stems not only from its impact on the patient's body, but also because of the severe disruption it has to the patient's overall quality of life. Here are a few key reasons why cancer pain is so important:
1. The prevalence and impact of pain
Research has shown that pain has become the fifth most critical vital sign in cancer treatment.
Cancer patients may experience pain at various stages of the course of the disease, and the nature and extent of pain may also change as the condition evolves.
Due to its high incidence and refractory nature, cancer pain seriously affects the quality of life of patients, making pain management an important part of improving the quality of life of patients.
2. Complex effects of long-term pain
The study found that cancer patients were more dependent on opioids than non-cancer patients, with a 1.22-fold increase in use.
Long-term pain and its treatment, such as long-term opioid use, can trigger or exacerbate a variety of other symptoms, including depression, anxiety, fatigue, insomnia, loss of appetite, and constipation.
These concomitant symptoms not only increase the physical suffering of the patient, but also exacerbate the mental and emotional burden, further reducing the quality of life.
3. Economic and treatment costs
Effective pain management can reduce the complications and additional treatments associated with pain, thereby reducing overall healthcare costs.
Ignoring cancer pain not only increases direct healthcare costs, but may also lead patients to seek medical help more frequently and increase indirect costs such as loss of labor.
4. Trends in clinical diagnosis and treatment
In order to improve the effectiveness of cancer treatment and the quality of life of patients, more and more attention is paid to the comprehensive management of pain.
Modern cancer treatment is increasingly focusing on multidisciplinary cooperation, and pain management has become one of the important indicators to evaluate the effectiveness of cancer treatment.
Therefore, effective management of cancer pain is not only necessary to improve the quality of life of cancer patients, but also a key component of modern comprehensive cancer treatment strategies. Through targeted pain management programs, the physical and psychological burden of patients can be effectively alleviated, and their treatment effects and living conditions can be improved.
How is cancer pain treated?
drug therapy
Drug therapy is a key aspect of managing cancer pain, and the so-called "three-tier" analgesic regimen is commonly used in clinical practice, which is proposed by the World Health Organization to intensify treatment according to the severity of the pain.
Step 1: Mild pain treatment
For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs) and nonopioid analgesics are commonly used. These drugs include:
Ibuprofen: Widely used to relieve mild to moderate pain.
Diclofenac: has strong anti-inflammatory and analgesic effects.
Acetaminophen (also known as paracetamol): Used to treat mild to moderate pain with fewer gastrointestinal side effects.
Indomethacin and celecoxib: are selective COX-2 inhibitors that reduce gastrointestinal adverse effects.
Second Tier: Moderate Pain Treatment
For moderate pain, weak-potency opioids, often in combination with nonsteroidal anti-inflammatory drugs, may be used to enhance pain relief:
Tramadol extended-release tablets: a synthetic weak opioid analgesic indicated for the management of persistent pain.
When necessary, these drugs can be combined with nonsteroidal anti-inflammatory drugs such as ibuprofen or acetaminophen to improve efficacy and reduce the dose of opioids.
Tier 3: Severe pain treatment
When pain reaches a severe level, strong opioids will be used, which may need to be combined with other types of medications to manage complex pain situations:
Morphine extended-release and oxycodone extended-release tablets: used to treat persistent severe pain.
Fentanyl Transdermal Patch: Provides stable blood concentrations for long-term pain management.
Anticonvulsants (e.g., gabapentin), antidepressants (e.g., amitriptyline), corticosteroids, etc., may be used in combination to enhance analgesia and manage specific types of pain (e.g., neuropathic pain).
This graded treatment regimen allows for the flexibility to adjust medication use to the patient's specific condition for optimal pain control. The choice of treatment at each step should be individualized based on the patient's pain level, drug response, and individual differences.
Traditional Chinese medicine (TCM) treatment
In 2019, the Hong Kong Clinical Research Centre of Chinese Medicine, School of Chinese Medicine, Hong Kong Baptist University published a guideline on cancer pain management titled "Hong Kong Clinical Practice Guidelines: Palliative Care for Cancer - Pain, Constipation and Insomnia", which points out that Chinese herbal diet, static qigong, qigong exercises, topical ointments or oils, bloodletting, auricular acupoints, cold or hot compresses, moxibustion, emotional counseling, sleep, etc. can all be used to relieve cancer pain.
Traditional Chinese medicine application: Acupuncture point application is to directly act on the surface of the body through the drug to achieve internal viscera, harmony of qi and blood, so as to achieve analgesic effect, modern medicine believes that the mechanism of action of external application of drugs is that the drug is absorbed through the skin to form a higher blood concentration in the local tissue, and with the blood circulation to achieve the effect of systemic treatment. It can not only reduce the sensitivity of pain receptors and achieve the effect of pain relief, but also avoid the gastrointestinal discomfort caused by oral administration, as well as the first-pass effect through the liver, especially suitable for cancer patients who are deficient in righteous qi and intolerant to attack
Moxibustion: Nursing staff through the heat stimulation of moxa strips or moxa pillars on the specific parts of the body surface, with warm meridians and channels to relieve pain, blood circulation and blood stasis, swelling and dampness effect, moxibustion and combined three-step pain, not only can improve the analgesic effect of the three-step analgesic method, but also can effectively reduce the obvious side effects caused by opioids, cancer patients should be targeted acupoints according to the specific tumor situation, such as lung cancer patients can choose Qi Ze, lung Yu, intestinal cancer patients can choose Shangyang, large intestine Yu, esophageal cancer patients can choose Tiantu, Jizhong, and so on.
Acupressure: It stimulates acupuncture points or skin through specific techniques, stimulates the flow of local "qi", accelerates blood flow and circulation, dredges the meridians, and achieves the effect of "passing without pain" and relieving pain as a whole. According to the patient's tumor condition, the corresponding acupuncture points can be selected, such as Zusanli, Huilai, etc. for gastric cancer, and the stage door and liver Yu can be selected for liver cancer, and the massage can be carried out according to the specific location of the acupuncture points, once a day, 15~20 min each time.
Music Therapy: According to the Yellow Emperor's Neijing, the five tones correspond to the five organs, namely Gong, Shang, Jiao, Zheng, and Yu, which correspond to the five internal organs, earth, metal, wood, fire, and water. Soothing and gentle music has an effect on the regulation of nerves and nerve humoral fluids, and at the same time promotes the secretion of hormones, enkephalins and other substances in the body, so that the vagus nerve excitability is increased, the effect of analgesia is achieved, and the immunity is improved.
Wrist and ankle acupuncture: Wrist and ankle acupuncture is a type of acupuncture therapy that takes the corresponding points from the wrist and ankle and performs subcutaneous acupuncture to treat diseases. In this therapy, the symptoms are grouped into 6 longitudinal areas on both sides of the body, and 6 needle insertion points are set at each wrist and ankle on each side. It has the effect of dredging the meridians and harmonizing the functions of the viscera. It is suitable for a variety of pain syndromes and visceral diseases.
Case sharing
Patient Guo, diagnosed with lung malignant tumor with multiple metastases, the patient long-term oral opioid pain relief, one day sudden lower abdominal distension and unbearable pain; after the relevant examination and examination to rule out obstruction, perforation and thrombosis, etc., considering the patient's advanced age, and long-term oral painkillers, poor gastrointestinal motility, intestinal qi stagnation is obvious, after wrist and ankle acupuncture, acupuncture point application of traditional Chinese medicine to retain enema, etc., the patient's pain is significantly reduced, and the number of subsequent occurrences is significantly reduced.
March 10, 2024
January 10, 2024
The Department of Integrated Traditional Chinese and Western Medicine Oncology of Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College) reminds patients:
When there is cancer pain, there is no need to be frightened and afraid, but it must not be ignored, and it must not be ignored in time, and the doctor will carefully evaluate, diagnose and treat it.
Authors: Xu Qingdi, Xu Wenqiang, Department of Integrated Traditional Chinese and Western Medicine, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College).
Correspondent: Le Xiwen Luo Shan
Editor: Huang Menglin
Reviewer: Xie Tao
Issued: Daley Red
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