How to standardize the diagnosis and treatment of cancer pain?

  Pain is one of the most common symptoms of cancer patients, which seriously affects the quality of life of cancer patients. The incidence of pain in first diagnosed cancer patients is about 25%; the incidence of pain in advanced cancer patients is about 60%-80%, and 1/3 of them have severe pain. If cancer pain is not relieved, patients will feel extremely uncomfortable, which may cause or aggravate anxiety, depression, fatigue, insomnia, loss of appetite and other symptoms, seriously affecting patients’ daily activities, self-care ability and overall quality of life. Cancer pain is widespread and standardized treatment is urgent. The Ministry of Health has decided to launch a nationwide activity of “Cancer Pain Standardized Treatment Demonstration Ward” from 2011 to 2013, and recently released the “Cancer Pain Treatment Standard” after experts’ preparation. “The Code outlines all aspects of cancer pain treatment and briefly introduces the causes, mechanisms and classification of cancer pain, which is helpful for doctors of various specialties to quickly understand the basic situation of cancer pain. “The Code introduces in detail the principles and methods of cancer pain assessment and proposes that cancer pain assessment should follow the principles of “routine, quantitative, comprehensive and dynamic” assessment. The specification includes three methods of quantitative cancer pain assessment, namely the numerical rating scale (NRS), the facial expression assessment scale and the pain rating scale (VRS), and recommends the Brief Pain Assessment Inventory (BPI), which facilitates quantitative and qualitative diagnosis of cancer pain from different perspectives according to different patients’ literacy and cognitive levels and provides a basis for cancer pain treatment by achieving accurate assessment.  The treatment of cancer pain is described in three aspects: etiological treatment, pharmacological pain treatment and non-pharmacological treatment.  I. Etiological treatment: i.e. surgery, radiotherapy or chemotherapy, etc., are given to cancer patients for anti-cancer treatment, which may sometimes relieve and alleviate cancer pain.  Drug analgesic treatment: The five basic principles of drug analgesic treatment for cancer pain are as follows: 1. Oral administration: Oral administration is the most common route of drug administration. For patients who are not suitable for oral administration, other routes of drug delivery can be used, such as subcutaneous injection of morphine, patient-controlled analgesia, transdermal patches, etc.  2.Use drugs according to the ladder: Take the World Health Organization (WHO) three-step analgesic treatment guideline for cancer pain as the guide, and choose different strength analgesic drugs according to the patients’ pain level.  3. Timely medication: It refers to regular administration of analgesic drugs at prescribed time intervals. Timely administration helps maintain a stable and effective blood concentration.  4.Individualized administration: It refers to the formulation of individualized medication plan according to the patient’s condition and the dose of cancer pain relief drugs. When opioids are used, there is no ideal standard dose of opioids due to individual differences, and sufficient doses of drugs should be used according to the patient’s condition so that pain can be relieved. Also, the nature of neuropathic pain should be identified and the possibility of combined medication should be considered.  5.Pay attention to specific details: Patients using painkillers should be supervised more closely, the degree of pain relief and organism reaction should be observed closely, the interaction of combined drug application should be noted, and necessary measures should be taken in time to reduce the adverse drug reactions as much as possible, with a view to improving the quality of life of patients.  3.Non-pharmacological treatment: The main non-pharmacological treatments for cancer pain treatment are: interventional treatment, physiotherapy such as transcutaneous acupoint electrical stimulation and psychosocial support treatment. Interventional treatment refers to interventions such as nerve block, nerve release, percutaneous vertebroplasty, nerve destruction surgery, nerve stimulation therapy and radiofrequency ablation. Epidural, intradural and plexus block routes of drug administration can effectively control cancer pain by single nerve block, reduce the gastrointestinal reaction to opioids and lower the dose of opioids. The expected survival time and physical condition of patients, the existence of anti-tumor treatment indications, and the potential benefits and risks of interventional treatment should be comprehensively evaluated before interventional treatment.  The standardized treatment of cancer pain requires close collaboration among medical and surgical oncology, pain, radiotherapy, anesthesia and other disciplines, and targeted education on pain management should be carried out to improve the knowledge of pain management among patients, their families and medical personnel. With the release of the “standard”, it will further standardize the treatment behavior of cancer pain in China, improve the standardized treatment system of major diseases, improve the level of cancer pain treatment in medical institutions, guarantee medical quality and medical safety, and further improve the quality of life of cancer patients.