It hurts! How to relieve the pain of spinal metastasis?

Author: Du Xinru, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Relevant data show that clinically, one-third of malignant tumors will metastasize. The metastasis rate in autopsies is higher than that in clinical practice, with approximately 60%-70% of tumor patients experiencing metastasis.

Spinal metastatic cancer, as the name suggests, refers to the metastasis of tumors in other parts of the body to the spine, causing a series of clinical manifestations in patients.

1. What are the main symptoms of patients with spinal metastatic cancer?

The most common symptom is pain. What are the characteristics of this pain? This pain is a kind of resting pain. In the early stage, it may be just discomfort. When the tumor grows to a certain extent, the pain will appear. It is mild during the day and severe at night. That is to say, it is mild when he is active and severe when he is resting. At night, the pain is so severe that he can't sleep. This is the characteristic of its pain.

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When it is very serious, the pain will get worse and worse, regardless of day or night. In addition to the pain in the metastatic area, the patient will also experience other symptoms.

If the metastatic cancer compresses the nerve roots, such as metastatic cancer in the thoracic spine compressing the intercostal nerves, it may cause intercostal neuralgia.

If the cancer metastasizes to the cervical spine and compresses the spinal cord, it may cause sensory and motor disorders in the lower limbs or sensory and motor disorders in the upper limbs.

If it is metastatic cancer of the lumbar spine, it may cause severe radicular pain in both lower limbs and back pain.

If it is metastatic cancer of the sacrum, sacral pain will occur, and cauda equina dysfunction will occur, which is a problem with defecation and urination.

2. What are the commonly used painkillers for patients with spinal metastatic cancer?

If the patient with metastatic cancer is in great pain, he should be given painkillers. In my country, there are generally the following types of painkillers:

The first type is non-steroidal anti-inflammatory analgesics, which are non-opioid drugs. Why do we use this type of drug? Because during the growth of the tumor, it will produce inflammatory factors. This inflammatory factor is called prostaglandin. Non-steroidal anti-inflammatory analgesics can be converted into prostaglandin inhibitors in the body, namely COX1 and COX2, which can effectively relieve pain. It is suitable for relatively mild pain and can be used if the pain score is less than three points.

The second type is weak opioid drugs, such as codeine, which is a weak opioid drug.

The third type is strong opioid drugs, such as morphine, fentanyl, and some tramadol, etc. These drugs have strong analgesic effects.

The fourth type of drug is a compound preparation, which is used for pain relief by mixing several drugs together to make a compound preparation. For example, aminophen and codeine contain both aminophenol-like drugs and codeine. There is also the compound OxyContin, which is a controlled-release tablet or sustained-release tablet of morphine, etc.

3. What should patients with spinal metastatic cancer pay attention to when using painkillers?

When giving patients painkillers, the first thing to do is to get enough. Generally speaking, if the amount we give patients is enough to relieve pain, it is considered enough.

Another thing is regular medication. What does regular medication mean? It does not mean taking the medicine only when you feel pain. It should be taken regularly every day, such as once every eight hours. Even when you are not in pain, you should take the medicine regularly according to this schedule.

Another one is combination therapy. What does combination therapy mean? If the dosage of a drug is too large, its side effects are also great, such as COX1 and COX2. If you take too much and your stomach becomes uncomfortable, what should you do?

We can consider the combined use of two or more drugs, such as taking Lexapro and adding codeine or tramadol, and taking some OxyContin and morphine controlled-release tablets orally, and using various drugs in combination.

Another way is to administer the medicine through different routes. For example, if oral medications have serious side effects, we can give him a suppository, which is to put a piece of medicine into his rectum and allow it to be directly absorbed by the rectal mucosa.

Figure 2 Original copyright image, no permission to reprint

Another is the transdermal patch, such as the fentanyl transdermal patch. As a transdermal patch, it is attached to the body like a plaster, penetrates the skin, and is absorbed by the fat. This can also achieve an analgesic effect, allowing patients to relieve pain while reducing side effects.

Of course, we must pay attention here. If the patient is very thin and has no fat, the absorption effect will not be good. If the patient is fatter and has thicker subcutaneous fat, the effect will be better after application.

Therefore, it is very important to choose painkillers based on the needs of the patient, adopt different methods of administration, or use different drugs in combination.

4. What should patients with spinal metastatic cancer pay attention to in their lifestyle and diet?

In life, the first thing is to adjust your mood and not have too much psychological pressure. Many people think that once they have metastatic cancer, that's the end of it, so psychological counseling is very important for such patients. Bad mood will indeed affect the patient's life span.

The second issue is to pay attention to preventing spinal fractures. Patients with spinal metastatic cancer should pay attention to specific protection of the spine, such as avoiding strenuous exercise, running and jumping. They can wear a brace for protection during exercise. This is a posture issue.

In terms of diet, you should pay attention to eating easily digestible food. Because patients with spinal metastatic cancer are often weak and their digestive tracts do not have such good digestive function, they should eat easily digestible food.

Another thing is to eat more laxative foods, including fruits and vegetables, and even use some laxatives or lubricants to keep bowel movements smooth.

Another thing is to strengthen nutrition and properly supplement some protein and sugar. Of course, many patients often have diabetes, so at this time, it is necessary to control the primary disease, control high blood pressure, and control diabetes.

Another thing is to participate in outdoor activities. Going outdoors, getting fresh air, and basking in the sun is also very beneficial to the patient's recovery.