【Special Planning】
Common misconceptions about analgesic use
Curated by a clean heart
Written by Wang Wen
Edited by Health Care Jun
Pain is both a symptom and a sign and a disease. Therefore, the treatment of "pain" is not simply "symptomatic". The mechanism of pain formation is relatively complex, and there are many methods of pain treatment in the current pain department, and analgesic drugs are only one of them.
Myth 1: If there is pain, you can bear it
Explanation:
Relatively speaking, middle-aged and elderly friends are more pain-tolerant, and many patients only seek analgesic treatment when the pain is too severe to bear, which is obviously wrong.
Tolerating pain is harmful and unhelpful for the patient and can even delay the condition. When do I need to seek help with pain? It mainly depends on the degree of pain and how it affects the patient.
The NRS score is a simple way to quantify the degree of pain, which divides pain from mild to severe on a scale of 0~10.
●A score of 0 indicates no pain.
●1~3 points, mild pain.
●4~7 points, moderate pain.
●7~9 points, severe pain.
●10 points is the limit of pain.
Usually mild pain is 1~3 points of pain, which generally does not cause adverse effects on patients and can be temporarily not treated; Moderate to severe pain over 3 points requires analgesic intervention.
In addition, if the pain has had an adverse effect on the patient, such as sleep or daily activities, analgesic intervention is needed.
Myth 2: With one medicine in hand, all pain will be eliminated
Explanation:
Based on the above introduction, we can understand that many structural injuries in the human body can cause pain, and these pains have specific types, and when the body has pain, we should first diagnose the possible causes of pain according to the type of pain, and then select and use appropriate analgesic drugs.
At present, there are many types of analgesics, each of which has a different mechanism of action, and the names of analgesics on the market are even more varied, but there is no single analgesic drug that can safely and effectively control all types of pain, and some analgesic drugs need to be used under strict supervision, and the appropriate analgesic drugs should be selected according to the specific situation of the individual.
In addition, the use of analgesic drugs is not a panacea, and for patients with a clear cause (eg, fracture pain, cardiac pain), it is necessary to actively treat the cause of pain to avoid delaying the disease, or treat it in combination with other analgesic means to reduce or eliminate the need for analgesics. Patients are also reminded that there is no best analgesic, only the most suitable analgesics.
Myth 3: Eat when you want, stop when you want
Explanation:
For nociceptive pain, NSAIDs and acetaminophen can be used when pain exceeds a certain level (NRS > 3) and can be discontinued when pain is controlled at a tolerable level (NRS ≤ 3), and is usually not recommended for more than 2 weeks.
For other types of analgesic drugs, such as antiepileptic drugs, antidepressants, opioids, etc., due to the peculiarities of the mechanism of action, onset time, drug metabolism, adverse reactions, etc., these drugs also have their particularities in use.
They are prescription drugs for specific pain types and should be started in small doses and gradually increased according to patient tolerance and efficacy until pain relief or intolerable adverse effects occur. Some medications are long-term, may need to be taken for several months to have an analgesic effect, and need to be tapered to stop when the drug is stopped to avoid uncomfortable symptoms.
Myth 4: During pain treatment, it is not necessary to communicate with medical staff
Explanation:
Due to the different causes of pain, during the pain treatment period, in addition to the regular follow-up and follow-up time required by the doctor, patients or family members are also required to contact medical staff in time if the following situations occur.
First, the patient's pain changes, such as intermittent pain that has recently become constant.
Second, the location of the pain changes, such as pain that is usually confined to the upper right quadrant, but recently the pain in the entire abdomen, or a new back pain.
Third, if the pain worsens for a long time or does not improve after treatment, it is also necessary to contact medical staff in time.
Myth 5: The treatment of cancer pain is the doctor's business, and patients and their families do not need to participate
Explanation:
Treating cancer pain is not only the doctor's job, but also the patient and their family need to be involved in the process, especially if the cancer pain is managed at home.
First of all, the patient should follow the doctor's instructions and take the medication as often as required, even if the pain is relieved, as prescribed. The goal of our treatment is to continue to control the pain, not just at the onset of the pain, and to follow the doctor's advice even if the medication is reduced or stopped.
Second, patients or family members are encouraged to keep a pain diary, recording the name of the drug used, the time and dosage of the drug, the degree of pain relief after taking the drug and the duration of analgesia, and the adverse reactions such as nausea, vomiting, constipation, etc., as shown in the table below.
Thirdly, patients should have regular follow-up visits in a timely manner, and should truthfully report these conditions to the medical staff during each follow-up visit, so that doctors can adjust the treatment plan in time according to this information to better treat the pain.
Fourth, the drugs used to treat cancer pain are most likely opioids, such as morphine, fentanyl, etc., which are narcotic drugs and are controlled by the state, so they must be stored in a relatively safe area of the home, such as a locked cupboard, to prevent children, adolescents or others from touching them.
Myth 6: Patients with cancer pain will become addicted to long-term use of painkillers
Explanation:
At present, opioids are mainly used for the treatment of cancer pain, such as morphine and fentanyl, which are generally not addictive under the premise of following clinical guidelines and standardized medication. People who use drugs inappropriately, such as the use of opioids for non-medical purposes, are drug abuse and have addiction problems, but cancer pain patients basically do not have addiction problems as long as they use drugs under the guidance of regular hospital doctors.
In clinical practice, there will be a situation that after taking drugs for a long time, patients with cancer pain will feel that the analgesic effect of the original dose of the drug is not as good as before or the analgesic maintenance time is shortened, and the dose of the drug must be increased to obtain the original therapeutic effect. The reason for this may be that on the one hand, it may be because the tumor progresses and the disease worsens, and on the other hand, it may be that patients with cancer pain have a higher "tolerance" to the drug, which is called opioid tolerance, which is an objective phenomenon that may occur in patients receiving opioid treatment, but tolerance is not the same as addiction.
Myth 7: Cancer patients can completely eliminate pain through cancer pain treatment
Explanation:
During cancer pain treatment, patients and their families should have a reasonable expectation of pain control. Cancer pain is not as easy to control as we imagined, not that the pain can be completely eliminated by taking two pills, we have also encountered a variety of pain treatment methods in our work, and the cancer pain still cannot be relieved, which also shows the complexity and refractory treatment of cancer pain on the other hand.
Eliminating pain completely is our common ideal goal, but it may be difficult to achieve in reality, and doctors will do their best to help patients relieve pain. The process of relieving pain is similar to going down steps, and each step is a small goal for us.
For cancer pain patients, our bottom line goal is to control pain at night and ensure that cancer pain patients rest and sleep as much as possible; On top of this, pain at rest during the day can be further controlled; In turn, the pain during activity is relieved.
This process is not achieved overnight, it may take a certain amount of time and repeated adjustments to the treatment plan, and each patient has individual differences in various treatments, so what patients and their families need to do is to trust the doctor, actively cooperate and give honest feedback.
There are many types of analgesic drugs currently used in clinical practice, and the specific drug names are even more varied, but there are currently two main drugs that can be bought directly without a doctor's prescription: one is acetaminophen, and the second is non-steroidal anti-inflammatory drugs. For most healthy adults, over-the-counter medications are still the preferred option for pain relief if they are used only occasionally.
However, it is advisable to seek medical attention when over-the-counter medications do not relieve pain, or if you have a health condition or need to take medication regularly.
I hope that every pain patient can achieve the best treatment effect under the premise of rational use of analgesics.
About the Author
Wang Wen
Doctor of Medicine, attending physician in the Department of Pain at China-Japan Friendship Hospital. He is mainly good at the diagnosis and treatment of degenerative diseases of the spine and bones and joints (such as neck and shoulder pain, low back and leg pain, knee osteoarthritis, lumbar intervertebral disc herniation, lumbar spinal stenosis, cervical spondylosis, osteoporosis related pain, etc.), drug treatment and surgical treatment of neuropathic pain (such as postherpetic neuralgia, diabetic peripheral neuralgia, trigeminal neuralgia, etc.), standardized drug treatment of cancer pain and central targeted analgesic surgery. He has undertaken and participated in a number of national, provincial and academy projects, and has published more than 10 articles in domestic and foreign journals as the first author.
The special planning content of this issue also includes "Rational and Correct Use of Analgesic Drugs", which can be read in the August issue of "Health Care for the Elderly" for more details
The above is the original work of the magazine "Health Care for the Elderly", if reprinted, it must be authorized by this journal!
This content is for medical science and is for reference only and cannot be used as a basis for diagnosis