1, Seventy to eighty percent of patients with advanced cancer face the threat of pain
2.The key to pain control is to master the correct pain assessment method and active prevention and treatment of adverse effects.
I. The main reasons why cancer patients fail to receive proper pain management
1.Improper pain assessment
2. Patients are overly concerned about morphine addiction and adverse reactions
3. Lack of experience in pain management and related problems among health care workers
II. Steps of pain treatment
(A) Correct pain assessment
1, the correct diagnosis of pain requires a detailed medical history
Causes of sudden onset, aggravation and reduction of pain: such as activity, cold, heat, eating, urination, defecation, etc.
Pain characteristics: real stabbing or dull pain, burning, abnormal sensation? like toothache or like colic
Specific site
Involvement site
Time course: continuous or intermittent? How long did it last? Did it occur suddenly or did it get progressively worse?
Associated symptoms: nausea, vomiting? Urinary urgency?
2. Assessment of the cause of pain
Is the pain related to physical activity? Yes – bone pain due to bone metastasis, chronic osteoarthritis, inflammation of other sites, tumor pleural metastasis
Is the pain recurrent colic? Yes – gastrointestinal tract, urinary tract disease
Is the pain worse after eating? Yes – digestive system diseases
Is the pain worse during urination or defecation? –Yes – constipation, hemorrhoids, infection
Is there any change in skin color, temperature and swelling during pain? Yes – bed sores, infection or venous embolism
Is the pain accompanied by abnormal sensation? Yes – neuropathic pain
Is the pain present? Yes —- visceral pain, inappropriate treatment, change in condition, poor patient compliance with treatment, combined depression
Under what circumstances can the pain be relieved? Effective therapeutic measures (reasonable medication, change of position, resting, distraction)
3.Past pain relief treatment
Drugs chosen, efficacy and side effects, duration of treatment
4.Whether there are comorbidities
Peptic ulcer, chronic liver injury, renal insufficiency, etc.
5. Necessary imaging data.
X ray, CT, MRI, PET/CT, bone scan, etc.
6.Pain level
The patient’s self-reported pain intensity is the best assessment method.
How is the diet
How to sleep
How active
Pain numerical score (0-10)
No pain: 0; Mild: 1-3; Moderate: 4-6; Severe: 7-10
7.Pain type assessment
Pain all the time —– visceral pain
Pain when moving —— bone pain
Burning, stabbing pain —— neuropathic pain
Appearing and disappearing ——- colic
Worse with inspiration —— pleuritic pain