Small size & big energy | Patient-controlled analgesia technology effectively controls cancer pain

Uncle Zhao, 73 years old, suffered from extensive small cell lung cancer with multiple metastases. After multiple courses of chemotherapy, radiotherapy, and targeted therapy, his condition continued to progress rapidly, with pleural effusion and metastasis to the thoracic spine and right humerus. The patient had obvious low back pain and humeral pain, chest tightness, and weakness, so he was admitted to our department. Uncle Zhao's most prominent problem was the pain caused by bone metastasis, so in terms of symptom control, we focused on relieving the pain: giving him oral OxyContin for pain relief, and the pain could be controlled. However, as Uncle Zhao's condition worsened, oral medication became increasingly difficult, and the number of breakthrough pains increased. After discussions with the anesthesiology team, we switched to an intravenous controlled analgesia pump (morphine pump) for pain relief, and Uncle Zhao's cancer pain was effectively controlled again, achieving painless activities, painless rest, and painless sleep. However, there were many twists and turns. One night, Uncle Zhao suddenly developed severe swelling and pain in his right upper arm. Medical staff escorted Uncle Zhao to do a CT scan of his right upper arm, and found a humeral fracture. They promptly asked the orthopedic department to give him local plaster fixation and immobilization. After adjusting the dosage of the analgesic pump, the pain was well controlled again, and the analgesic pump maintained a satisfactory effect until Uncle Zhao died. Here, let me popularize what is patient-controlled analgesia technology ?

Patient controlled analgesia, or PCA for short, is a controllable microcomputer system-operated device that pre-sets the dosage of analgesics by the doctor and then gives it to the patient to manage. This achieves "self-management" of pain. PCA administers medication through a PCA pump. When the patient is aware of the pain, the analgesic can be injected into the body through a controller to achieve the purpose of pain relief.

Advantages of PCA analgesia technology : PCA technology is a pain management technology in which medical staff pre-set the dosage of analgesics according to the patient's pain level and physical condition, and then leave it to the patient to "self-manage".

Safety: Continuous and stable infusion, stable drug concentration in the blood, stable analgesic effect, and small side effects. Convenient: When the patient is in pain, he presses the PCA pump by himself to relieve pain on demand, reducing the waiting time for the patient to be treated when in pain. Effective: Press the PCA button, it takes effect quickly (1-3 minutes), has a good analgesic effect, and can effectively control explosive pain. Suitable for: those who cannot take analgesics orally (such as dysphagia, gastrointestinal dysfunction, digestive tract tumors); those who have severe side effects of oral analgesics (severe gastrointestinal reactions, severe dizziness, cardiopulmonary complications, etc.); those who take too much oral analgesics and have frequent explosive pain, etc.

PCA analgesia technology is one of the effective means of cancer treatment. The appropriate route of administration should be selected according to the patient's specific situation. If it can maximize the patient's comfort, intravenous, subcutaneous, rectal, transcutaneous, transmucosal and other routes can be considered. PCA is one of the commonly used methods. The most commonly used drugs in PCA analgesia pumps are morphine injection or hydromorphone injection. Existing evidence has failed to show which of morphine, hydromorphone, oxycodone, oxymorphone, fentanyl, etc. is more effective. Prospective studies have shown that hydromorphone effectively relieves pain that cannot be controlled by other analgesics.

Based on economy, accessibility and the patient's condition, the opioid drug used in Mr. Zhao's patient-controlled analgesia pump (PCA pump) is morphine injection, which has a clear analgesic effect, good safety, and can greatly alleviate pain.