Patients with cancer pain, most of them have psychological problems, which are more prominent with the duration of pain and the strengthening of pain level. In cancer pain treatment, medical personnel should pay attention to patients’ psychological problems, especially for patients with severe pain, and it is necessary to provide psychological treatment while giving analgesia to reduce the influence of psychological problems on pain and improve patients’ analgesic effect and quality of life.
I. Indications for psychological treatment of cancer pain
1.Old and frail cancer pain patients
In clinical work, it is very difficult for many old and frail patients to carry out cancer pain treatment, the use of analgesic drugs is in an unstable state, the effect is sometimes good and sometimes bad, and the use of analgesic drugs is also prone to some adverse reactions.
2.Patients with serious side effects of analgesic drugs
Due to long-term chronic consumption and periodic treatment, cancer patients often have weak digestive tract function, and the long-term use of analgesic drugs is bound to have certain impact on digestive tract function, and patients have a heavy psychological burden.
3.Severe cancer pain patients
In patients with advanced cancer pain, patients are usually accompanied by depression, anxiety and other psychological reactions, and even have suicidal tendency. Therefore, in clinical practice, for patients with severe cancer pain, attention should be paid to psychological problems and the presence or absence of suicidal tendency, and the joint use of psychotherapy is conducive to relieving pain and improving psychological status.
II. Role of psychotherapy for cancer pain patients
1.Improve bad mood
2.Enhance positive coping response
3.Seeking social support
4.Improve digestive function and resistance
5.Reducing pain and side effects of treatment
Psychological treatment methods for cancer pain
1. Supportive psychotherapy.
When a person encounters social problems such as serious setbacks in work, study, life or interpersonal relationships; breakup of love marriage or family; or mental tension, emotional disorder, intense psychological contradiction, even negative pessimism and suicidal ideas caused by mental and physical diseases, supportive psychotherapy is needed. In case of suicide, supportive therapy is needed. Even if the disease has reached an advanced stage, or has become disabled, supportive therapy can be used to guide them to face reality and encourage them to think about meaningful things in life to make their mood happy. Supportive therapy is also used at the end of life to help patients pass away peacefully.
When conducting supportive therapy, the therapist must treat the patient with enthusiasm and a high degree of sympathy for their physical and mental suffering, and respect their ideas and practices even if they are not right.
(1) Listening: The therapist should be good at listening to the patient’s narrative under any circumstances, no matter how long-winded and how excited they are, they should listen carefully and patiently, not only to understand the patient’s condition, but also to make the patient feel that the therapist cares about their suffering very seriously, thus creating a sense of trust, feeling that they are not alone, and building up courage and confidence. In addition, the patient will feel much more relaxed if he or she confides in the patient.
(2) Explanation: After a trusting relationship has been established with the patient and a full understanding of the patient’s problem has been gained. The patient often cannot remember that much, so the therapist should use easy-to-understand language and repeat the advice and counseling several times so that he can understand it carefully after the conversation.
(3) Reassurance: It is useful to give reassurance when the patient is anxious and distressed, especially when he is in a momentary crisis. However, if the patient does not know enough, the patient will feel cheated and the treatment will be ruined if the assurance cannot be realized. When talking about the prognosis of the disease, the therapist should give the patient enough confidence and answer as much as possible to the good side, and can attach several hopes and suggestions, such as quitting smoking, eating more, etc.
(4) Advice: Once the therapist has established a position of authority in the patient’s mind, the advice he gives is only powerful. However, the role of the therapist is to help the patient analyze the problem, from which the patient learns the focus of the problem, usually by the therapist giving advice and counseling, while allowing the patient to find out the solution to the problem themselves and encouraging them to take the first step.
(5) Adjustment of the relationship: When the therapist provides too much support to the patient, the patient tends to become dependent and wants the therapist to take charge of any problem. When this happens, they should be gradually guided to place their hope in a broader group of people such as relatives, units, etc.
2., Cognitive therapy.
A common clinical treatment method based on the principle of cognitive therapy is called ABC technique, in which A (Acting Stimulus) represents stimuli, B (beliefs) represents personal perceptions, and C (emotional and behavioral consequences) represents emotional and behavioral consequences, usually we only notice the relationship between A and C, and even think that A One of the tasks of the therapist is to adjust the patient’s misconceptions into reasonable, scientific, realistic, rational, positive, relatively beneficial and relatively small loss, etc. Therefore, we should achieve good doctor-patient relationship → detailed patient care. Therefore, we should achieve good doctor-patient relationship → detailed patient information → identify wrong cognitive views → correct the wrong views → produce relatively good results.
Psychopharmacological treatment of cancer pain
1.Tricyclic antidepressants (TCA)
The dose range of TCA is limited by sedation, anticholinergic and cardiovascular toxicity, generally the common dose is 50-100 mg per day, TCA must be started from small dose, generally from 12.5 mg, according to the patient’s tolerance and improvement of symptoms, and then increase 12.5-25 mg every 2-3 days as appropriate. -25 mg. Until the condition improves, the maximum daily dose should not exceed 100 mg.
2.Selective 5-hydroxytryptamine reuptake inhibitors (SSRI)
(1) Paroxetine: endogenous depression, symptomatic depression, can be used. Usage and dosage: dosage of 20-50 mg / day, most patients with 20 mg / day can achieve satisfactory results, due to the drug’s half-life of up to 24 hours, can be given once a day. Common adverse reactions include nausea and vomiting, which tend to decrease with continued use. In addition, sexual dysfunction, urticaria, etc. may be seen. Contraindications: Contraindicated in persons with hypersensitivity to paroxetine and prohibited in combination with MAOI.
(2) Sertraline: Indications: Sertraline can be used for the treatment of depression due to various causes. Dosage and Administration: Adults take the drug once a day, with or without food, either early or late. The usual effective dose for the treatment of depression is 50 mg/day. In a small number of patients with poor efficacy and good tolerance of the drug, the dose may be increased gradually over several weeks by 50 mg at a time to a maximum of 100 mg/day once daily, depending on the efficacy. The effect of the drug can be seen in about 7 days, but the full effect of the drug will be seen in the second to fourth week of treatment. A small number of particularly sensitive patients have shown some efficacy at 25 mg/day. Long-term dosing should be adjusted according to efficacy and maintained at the lowest effective therapeutic dose. Dosing should be limited to 50 mg daily in elderly patients.
Adverse Reactions: Possible reactions to sertraline compared to the placebo group in multilevel drug dosing studies for the treatment of depression include: nausea, diarrhea, loose stools, anorexia, dyspepsia, tremor, dizziness, insomnia, drowsiness, excessive sweating, dry mouth and sexual dysfunction.
Contraindications: Sertraline is contraindicated in persons with hypersensitivity to sertraline. Sertraline is prohibited to be used in combination with monoamine oxidase inhibitors.
(3) Vanlafaxine: Indications Indicated for various depressive states.
Dosage and Administration: The starting dose is 25 mg/day, divided into two or three doses with meals. The dose can be gradually increased according to the condition and tolerance, generally the highest dose is 100 mg/day, divided into three oral doses. Common adverse reactions include nausea, vomiting, headache, weakness, sweating, drowsiness, insomnia, dizziness, nervousness, dry mouth, anxiety, anorexia, weight loss, rash, abnormal male ejaculation or impotence. Less frequent adverse reactions include tachycardia, elevated blood pressure and abnormal renal function, mildly elevated serum cholesterol, blurred vision, reversible bone marrow suppression and sexual dysfunction.
Contraindications: Contraindicated in patients who are hypersensitive to this product and are taking monoamine oxidase inhibitors.
3.Anxiolytics
(1) Commonly used drugs are Valium, Nitro Valium, Clonidine.
Valium 2.5 mg-5 mg daily, nitro Valium 5 mg-10 mg daily, clonidine 1 mg-2 mg daily.
(2) Buspirone: It is a new drug discovered in recent years, and its pharmacological properties are completely different from BZ.
There are many controlled studies showing that it is as effective as BZ in anxiety disorders, with the advantages of no tolerance, no risk of abuse, and no significant sedative effects along with anxiolytic effects, so it generally does not affect patients’ daily functioning.