Don't just bear it, there are ways to relieve the pain of advanced cancer

□ Li Shijie and Shen Yuchen

Cancer pain is one of the most common symptoms of cancer patients, and is common in more than half of cancer patients. Especially for patients with advanced tumors, cancer pain greatly reduces the quality of life of patients during their survival with tumors. How can patients with advanced tumors "coexist peacefully" with cancer pain?

Drug treatment adopts "three-step therapy"

First, correctly assess cancer pain. Patients can choose the number that best describes the intensity of pain based on their own pain situation and tell the medical staff. Secondly, follow the principles of multidisciplinary comprehensive treatment and individualized treatment for cancer pain scoring. At present, the treatment of cancer pain mainly includes drug and non-drug treatment. If the pain score is above 4 points, it is recommended to use drugs for analgesic treatment.

For cancer pain, the three-step therapy recommended by the World Health Organization is currently widely used in clinical practice. According to the different degrees of pain, such as mild, moderate and severe, the first step (non-steroidal anti-inflammatory drugs represented by aspirin), the second step (weak opioids represented by codeine), and the third step (strong opioids represented by morphine and oxycodone) are used alone and/or in combination with other necessary auxiliary drugs to treat cancer pain. Related studies have suggested that if the patient's pain persists, consider using analgesics regularly; if 4 or more doses of short-acting opioids are required every day, the patient should add a long-acting opioid to the total daily dose or increase the dose of long-acting opioids.

When patients take opioids, they should pay attention to the following points. First, give the medicine on time, regardless of whether the patient has pain at the time of administration, to ensure continuous pain relief; second, individualize the medication, and use an appropriate dose to control pain without unacceptable side effects. Follow the doctor's advice to start with a small dose and gradually increase until the pain is relieved. Opioids have no ceiling effect, and an analgesic dose can always be found; third, pay attention to details, pay attention to the side effects of the drug during medication, whether the patient's pain is relieved, sleep at night and rest during the day, and whether pain occurs during activities.

Traditional Chinese medicine external treatment has no side effects and dependence

Non-drug treatment plays an irreplaceable role in the treatment of cancer pain, and TCM external treatment is one of the most widely used treatment methods. TCM believes that "pain occurs when there is no circulation" and "pain occurs when there is no nourishment", and the pathogenesis is due to poor circulation of qi and blood and blood vessel congestion. Therefore, TCM external treatment should focus on promoting blood circulation and removing blood stasis, promoting qi and relieving pain, and provide comprehensive conditioning.

Doctors often use acupoint application, selecting acupoints such as Ashi, Hegu, Geshu, Xuehai and Sanyinjiao to achieve the effect of promoting blood circulation, promoting qi and relieving pain. Ear acupoints can reduce the side effects of opioid analgesics. External application of Chinese medicine can effectively improve cancer pain caused by bone metastasis, and soaking in Chinese medicine can relieve chemotherapy-induced peripheral neurotoxic pain and hand-foot syndrome pain caused by chemotherapy. Ironing the abdomen with Chinese medicine can effectively improve constipation symptoms in patients taking opioids. External treatment of traditional Chinese medicine has no side effects and dependence, and can improve patients' symptoms and quality of life.

Correcting some common misconceptions

Myth 1: Opioid painkillers should not be used unless absolutely necessary.

If the pain is not effectively relieved for a long time, the tumor will have the opportunity to develop further. Most pain can be well controlled by oral medications.

Myth 2: Pain relief treatment is sufficient as long as it can partially relieve the pain.

Pain relief is the key to improving the quality of life of patients with advanced cancer pain. The minimum requirement for pain relief treatment is to achieve pain-free sleep, followed by pain-free rest and pain-free activities.

Myth 3: Long-term use of morphine painkillers can cause addiction.

After taking opioids for a period of time, patients may need to increase the dosage of the drug. This is due to increased pain intensity or drug tolerance. The increase in the dosage requirement is not a sign of morphine "addiction". As the disease improves and the pain decreases, the dosage of morphine can be gradually reduced.

Myth 4: If side effects occur while taking painkillers, the medication should be stopped immediately.

The main side effects of opioids are constipation, nausea, vomiting, drowsiness, urinary retention, intestinal obstruction and respiratory depression, among which constipation has the highest incidence. Other reactions will disappear within a few days and there is no need to stop the drug.

(The author Li Shijie is the director of the First Oncology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, and Shen Yuchen is the attending physician of the First Oncology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine)