Patients with advanced cancer usually have many complications and are more serious, of which pain is the most common symptom, while bone metastatic pain is the most representative pain of malignant tumor cancer pain, which will gradually worsen as the disease progresses.
At first, the pain in patients is mostly intermittent dull pain, and continues to worsen, which may occur at night, and some patients have increased pain after activity; and as the tumor continues to grow, a second type of pain will appear - breakthrough pain, which is a temporary pain of burning sensation, the onset of which is usually acute and difficult to foresee, so the pain is often intense and difficult to completely control.
Recently, a patient's family asked, "Lung cancer bone metastasis, the mother is particularly painful every day, the use of painkillers but still pain, can you take Chinese medicine to relieve pain?" ”
Today, I will talk to you about the pain treatment of advanced cancer pain.
Bone metastatic cancer pain treatment should be treated at different times!
Professor Ao Jienan of le Qisheng's TCM team (doctoral supervisor of integrated traditional Chinese and Western medicine, enjoying special government allowances of the State Council) pointed out that the pathology, clinical symptoms and body reactions of patients with different tumors are very different at different times, so the treatment of cancer pain should be treated according to the pathological characteristics and changes of different treatment periods and different disease periods where patients are located, that is, "dialectical treatment", which is also a supplement to the diagnosis and treatment of diseases and dialectical treatment.
Professor Ao believes that most patients with bone metastatic cancer pain are in the middle and advanced stages, so it is advisable to focus on correcting them. Patients often have fatigue, poor appetite, self-sweating, physical fatigue, mental atrophy and other symptoms of spleen deficiency, kidney deficiency, identification and treatment is mostly based on healthy spleen and kidneys, healthy qi; and combined with the different treatment periods in which the patient is located, for example, if the bone metastases patient is currently in the radiotherapy period, then Chinese medicine treatment should be administered to activate blood detoxification, nourish the yin and supplement the deficiency; if the patient is in the chemotherapy period, because chemotherapy is easy to lead to bone marrow suppression, digestive tract adverse reactions, etc., so Chinese medicine treatment should be based on nourishing yin and nourishing blood, healthy spleen and beneficial qi.
It can be seen that the treatment of traditional Chinese medicine and Western medicine is not "either/or", the treatment of tumor patients should be holistic and multidisciplinary, whether it is traditional Chinese medicine or Western medicine, all treatment should take "people" as the core, around alleviating the pain of patients and prolonging life. Therefore, in the treatment of tumors, Chinese medicine, Western medicine is like people's left and right hands, the advantage of Western medicine is accurate and aggressive, but the disadvantage is that the target is single, it is difficult to achieve overall conditioning, at this time, the treatment of Chinese medicine can make up for its shortcomings; and Chinese medicine also has the strength to catch the place, such as cancer is not strong enough, the effect is slow, and the fast onset and aggressiveness of Western medicine can make up for its shortcomings.
Clinical studies have also shown that bone metastatic cancer pain is the main clinical symptom of bone metastasis, and its pathogenesis is more complex, mainly manifested in two aspects: on the one hand, when cancer cells metastasize, cancer cells can produce osteoclast stimulating factors, stimulate osteoclasts to increase the activity of osteoclasts, and then enhance bone resorption, resulting in bone destruction; on the other hand, the continuous progress of tumors and bone destruction, resulting in pain-related factors will continue to be released from metastases, stimulating human pain nerves, resulting in increased pain. These mechanisms often involve changes in the entire bone microenvironment, so the treatment of bone metastatic cancer pain requires holistic treatment, and the clinical method of comprehensive treatment is often used.
Therefore, while using painkiller patches or painkiller injections, it can be combined with traditional Chinese medicine treatment to minimize pain.
In the actual treatment, Professor Ao also pointed out that the treatment of tumors must pay attention to the care of spleen and stomach function, which is of great significance for enhancing the patient's own anti-cancer ability and controlling tumor progression. Because the spleen and stomach are responsible for the digestion of food, but also an important source of human nutrition, when the spleen and stomach problems, tumor patients are not nutritionally sufficient, it is easy to have cachexia, which can lead to the serious complication of death; and the patient's spleen and stomach function is weak, the body is more weak, the patient's disease resistance is weak, and even can not withstand the related treatment of bone metastatic cancer pain.
Therefore, in the dialectical treatment, it is commonly used in astragalus, eucommia, epimedium, silk seed and other spleen-strengthening and kidney-enhancing Chinese medicines. And on the basis of the principled use of the World Health Organization's three-step analgesics, the addition of Chinese herbal medicines that can alleviate adverse reactions such as constipation, nausea, vomiting, itching and other adverse reactions caused by three-step analgesic drugs, but also have analgesic effects, such as rhubarb, laurel branch, fumaline, ice flakes, dragon blood exhaustion, etc.
Case sharing
Ms. Cao, 49 years old, was diagnosed with right lung adenocarcinoma 2 years ago, and PET-CT showed multiple lymph node metastases in right middle lung cancer; L4 vertebral body FDG was elevated, bone metastasis was considered, and then repeated chemoradiotherapy treatment was carried out, and the last chemotherapy was carried out on March 5 this year. "Zoledronic acid" anti-bone metastases are performed several times during the course of the disease. CT on June 22 this year suggests multiple Thoracolumbar vertebral hyper-density opacities, considering bone metastases. Currently, patients are using fentanyl patches topically for pain relief. However, the pain was still repeated, so I came to seek Chinese medicine treatment.
Symptoms at the time of visit on June 27: fatigue, sometimes cough, white sticky sputum, occasionally a little sputum with blood, slight sore throat, right chest pain, slight chest tightness, slight wheezing after activity, bloating, poor appetite, occasional pantothenic acid, dry stool, 2-3 days of a line. The tongue is reddish, purple, and the moss is slightly greasy. Self-imitating anti-cancer anti-cancer anti-analgesic formula.
Prescription: Nanbei sand ginseng, raw astragalus, Qing Banxia, golden buckwheat, moxibustion aster, snake tongue herb and other more than a dozen herbs, 7 doses, decoction, 1 dose per day, divided into morning and evening twice. Patients are instructed to continue to use fentanyl patches for topical pain relief.
Second diagnosis on July 5: the patient was weak, coughed, coughed, no sputum with blood in the sputum, sore throat slightly better than before, pain in the right chest slightly better than before, chest tightness, slightly asthma after activity, abdominal distension slightly better than before, still poor appetite, pantothenic acid reduced, stool slightly dried knots. The tongue is reddish, purple, and the moss is slightly greasy. Ultrasound in patients suggests bilateral pleural effusions (79 x 40 mm on the right, 60 x 47 mm on the left).
Treatment plan: (1) the patient has bilateral pleural effusion, chest tightness, slight asthma after activity, it is recommended that he carry out chest puncture catheter drainage chest fluid; (2) Chinese medicine prescription with evidence, add amaranth on top to facilitate horizontal asthma, add chicken gold to improve appetite, take care of stomach qi, continue to take 7 doses; (3) continue to use fentanyl patch for external pain relief.
Follow-up treatment, adjust the treatment plan and TCM medication according to the changes in the condition, by September 12, the pain is no longer obvious, the appetite has improved, the physical strength has increased significantly compared with before, and the review indicates a small amount of pleural effusion.