Controlling tumor is more important than controlling pain Many doctors think that cancer pain is something that patients have to bear, and it will naturally stop when the tumor is cured. Or they think that pain treatment is only a symptom treatment, which can only improve the symptoms and has little significance; anti-tumor treatment is the root of the problem. They think that controlling tumor is more important than controlling pain, and analgesics should be used only when the pain is severe, and analgesic treatment can make the pain partially relieved. However, in fact, for patients, pain control is as important as tumor control. The earlier the treatment, the better the effect, and it is better to do both simultaneously. Because only when the pain is well controlled, the patient’s condition will be good and it will be more conducive to the treatment of tumor. Only use analgesics when the pain is severe For pain patients, timely and on-time medication is safer and more effective, and the strength and dose of analgesics needed are the lowest. In addition, long-term pain can cause a series of pathophysiological changes that affect the emotional and psychological health of patients, and even sympathetic nerve dysfunction related to neuropathic pain caused by pain, which manifests as intractable pain such as nociceptive hypersensitivity and abnormal pain. Therefore, the occurrence of pain should not be delayed and should be treated promptly. Non-opioid drugs are safer Opioids interact with central specific receptors to relieve pain. However, high doses can lead to miosis, coma, and respiratory depression. Many clinicians believe that opioids are unsafe and are therefore reluctant to prescribe them to patients. In fact, opioids are safer and more effective for patients who require long-term analgesic medication. In patients who have not received opioids previously, high doses of opioids may result in respiratory depression and central nervous system adverse effects. However, if the dose is titrated correctly, adverse drug reactions can be avoided. In contrast, long-term application of NSAIDs can cause gastrointestinal and renal toxicity, and can significantly inhibit platelet function. Large doses of acetaminophen can cause liver toxicity, and the Chinese Pharmacopoeia states that the daily dose of this drug should not exceed 2g/day and should not be taken continuously for more than 10 days. In particular, acetaminophen can cause an increased risk of liver injury in patients who have a history of alcohol consumption. Therefore, when used correctly, opioids are safer than NSAIDs for analgesia. Dulcolax if you can’t take it The World Health Organization (WHO) has listed dulcolax as a drug not recommended for cancer pain treatment. The analgesic effect of dulcolax is only 1/10 of morphine, and its metabolite, norethindrone, has a long clearance half-life, taking about 13 hours to be completely excreted from the body, and has potential neurotoxicity and nephrotoxicity. The continuous use of dulcolax not only does not increase the effect of pain relief, but also causes a large accumulation of norethindrone in the body, which will seriously stimulate the central nervous system and cause delirium, tremor, confusion, convulsions and other mental abnormalities and respiratory difficulties, especially for those with renal insufficiency, the toxic side effects are even greater. Because of the poor oral absorption and utilization of dulcolax, it is mostly administered by intramuscular injection. Intramuscular injection itself will produce pain and should not be used for cancer pain treatment. If patients cannot take oral pain medication, there are other analgesic methods such as fentanyl transdermal patch and intrathecal morphine pump. Some studies have shown that patients are prone to addiction with long-term use of dulcolax for pain relief. Due to these drawbacks, WHO has classified Dulcolax as a non-recommended drug for pain management. Vomiting should be discontinued after taking the drug. Adverse reactions such as vomiting and sedation usually occur only in the first few days of use, and the symptoms can mostly disappear on their own after a few days. Active preventive treatment of opioid adverse reactions can reduce or avoid the occurrence of adverse reactions. Since opioids have the adverse effect of respiratory depression, many clinicians worry that patients with lung cancer and metastatic lung cancer may have reduced tolerance to opioids due to poor lung function. However, in fact, patients with lung cancer pain can safely use opioid painkillers. This is because dyspnea caused by lung disease is the result of lung lesions, and opioids inhibit breathing as a central effect of the drug. Opioids themselves do not aggravate pulmonary pathology. Also, the side effects of opioids on the respiratory center generally occur only in the case of overdose, especially if the peak blood concentration rises sharply. Withdrawal symptoms will definitely occur if the drug is stopped too soon Clinical practice has proved that as long as the pain of cancer patients is controlled or eliminated, they can reduce or stop the use of opioid analgesics at any time and will not have withdrawal symptoms. When the daily dosage of morphine is 30~60mg, sudden discontinuation of the drug will generally not cause any accident. For patients with long-term high doses, the method of gradual dose reduction and discontinuation is used, i.e., the dose is reduced by 25%~50% in the first two days, and then reduced by 25% every two days until the daily dose is 30~60mg. If more serious pain symptoms occur, the dosage should be reduced slowly.