What to do if “cancer pain” cannot be controlled by oral painkillers
Pain is the most common symptom of cancer patients and the main reason affecting their quality of life. 1986, the World Health Organization (WHO) issued the “Principles of Three-step Pain Management for Cancer”, which recommended the implementation of a three-step pain management program for cancer worldwide. According to the three-step treatment principle, nearly 80% of patients can have basic pain relief, but 20% of patients cannot solve their pain problems due to ineffective oral administration or high side effects of oral opioids, which seriously affects their quality of life.
In 1998, the Chinese Pain Society proposed the “fourth step” of pain relief treatment for cancer pain – interventional treatment, which refers to the pain relief treatment of cancer pain patients through interventional surgery, including: Fan Bifa, National Pain Treatment Center of Beijing China-Japan Friendship Hospital
1. Nerve block: peripheral nerve block, nerve root block, sympathetic nerve block, etc.
2. Nerve radiofrequency destruction: belongs to the category of physical nerve destruction technology, which is the application of radiofrequency thermal coagulation apparatus to act on the responsible nerve for physical destruction to achieve the purpose of pain relief.
3. Drug nerve destruction: It belongs to the category of drug chemical nerve destruction techniques, including the application of anhydrous alcohol and phenol glycerol for subarachnoid and ventral plexus block, etc.
4.Intravertebral pain relief
5.Spinal cord electrical stimulation therapy
6.Central target control therapy.
The above methods can be used as an effective supplement to the World Health Organization’s “three-step drug treatment program for cancer pain” and can basically meet the analgesic needs of patients with intractable cancer. Based on accurate assessment, the clinical indications and treatment methods should be reasonably selected. Our center has widely applied the above interventional techniques in clinical practice and achieved good results, bringing new hope to patients with mid- to late-stage and intractable cancer pain.
Introduction of several surgical techniques.
1.Drug nerve destruction (abdominal plexus block).
Abdominal plexus ethanol block treatment is used for pain caused by upper abdominal tumors, especially pancreatic cancer pain, and about 60-85% of patients can obtain pain-free. The procedure is within the scope of minimally invasive surgery, and special puncture needles are applied to precisely locate and puncture into place under X-ray fluoroscopy, and anhydrous alcohol is injected for the block to obtain the best results. The effect of ethanol is good and long lasting. In elderly, debilitated & advanced patients, the results of nerve-destroying drugs are better than surgical procedures. Pain relief lasts up to 5 weeks to 4 months.
2. Central target-controlled analgesic technique.
Central target-controlled analgesia, also known as programmable drug infusion pump technology, is one of the most advanced methods in the international pain community in recent years for the treatment of cancer pain and chronic intractable pain such as central pain and postherpetic neuralgia.
This method can directly apply drugs to the spinal cord and brain, and the dose of applied drugs is only 1/300 of the dose needed for oral administration, avoiding the toxic side effects caused by large amounts of oral medication, and can write corresponding programs for targeted drug delivery and personalized services for patients with different conditions and different pain patterns, which can achieve satisfactory analgesic effects. Its biggest advantage is safety, less trauma, remarkable efficacy, simple operation, good patient tolerance and less complications, and it is suitable for all patients with cancer pain and chronic intractable pain who are ineffective by other traditional treatment methods and medication, or cannot tolerate the side effects of medication, with high success rate.
The treatment of various types of intractable pain by central target-controlled analgesia has been carried out overseas for a long time and has achieved very good clinical results. This technology has been carried out in our center since 2003, and nearly 100 cases have been carried out so far.
3.Spinal cord electrical stimulation therapy.
The neuralgia caused by radiotherapy is opioid non-responsive pain, at this time, the nerve modulation technique is very important. The spinal cord stimulation electrodes are implanted in the corresponding spinal cord stages, and the spinal cord stimulation is carried out by sending electrical stimulation waves through the connected stimulator to achieve neuromodulation and achieve pain relief.
4. Nerve-destructive treatment.
Cancer bone metastasis is a common cause of bone pain. Bone metastatic cancer pain syndrome is a temporary aggregation of various pain symptoms and signs with certain characteristics during the disease development of cancer patients. This syndrome is mainly due to the compression of bone pathways and nerve tissues. Since bone pain is opioid semi-responsive pain, it requires neurodestructive treatment. Depending on the condition, physical or chemical nerve destruction treatment can be chosen.
5. Epidural pain relief.
Epidural analgesic technique is a method of injecting pain medication into the epidural cavity to block spinal nerve conduction and produce segmental analgesia. Epidural cavity block can block both the somatic and autonomic nerves, and the blocking range is larger and the effect is exact. Because the epidural cavity block technique is simple to operate, with little damage and exact effect, it is widely used in clinical practice.
The mechanism of cancer pain is very complicated and has many reasons, and the degree of pain will increase as the disease changes. laying a good foundation for the treatment of cancer.
With the rapid development of pain medicine in China, various pain relief techniques are widely used in clinical practice, bringing a new light to people who are suffering from cancer pain. Having cancer is unfortunate, having a heart that never gives up and insisting on an optimistic, strong and upward-looking mentality can make an unfortunate life less gray. This respect for life inspires us as well. Please believe that there is a joint effort between us and you on this difficult road, and that pain doctors can apply their skillful expertise to help more cancer patients to be able to show a wonderful life on the road of fighting cancer: painlessly!