Patients with advanced cancer should not spend the rest of their lives in pain. Pain is a problem that most cancer patients have to face. In reality, many advanced cancer patients are tormented by pain for the rest of their lives, now we talk about this topic: Why is the pain problem always poorly solved? On the part of medical personnel, they lack the knowledge of standardized treatment of cancer pain, or they do not have standard evaluation of pain, or they do not give enough dose of medicine; on the part of patients, they are reluctant to use painkillers for fear of addiction, or they are afraid of adverse drug reactions, or they are worried that they cannot afford the medicine beyond their ability to pay; on the part of medical administration, they do not pay attention to the treatment of cancer pain, or they are too strict in the management of narcotic drugs, or the supply of drugs involving anesthesia is insufficient, etc. What are the drugs for cancer pain treatment? What are the side effects of each drug? How to use them reasonably? 1.NSAIDs: NSAIDs are the drugs of choice for mild pain and are commonly used in clinical practice for patients with mild to moderate pain; the specific indication for the use of NSAIDs is pain accompanied by inflammatory reaction of tumor peripheral tissues, such as skin metastasis nodules or infiltration, and another indication is pain caused by bone metastasis; NSAIDs do not produce drug resistance and have no physical or psychological dependence. When used alone, their analgesic effect has a ceiling effect, so the dose used should not exceed the limit dose on the package insert. NSAIDs have different analgesic mechanisms from opioid receptors, and the analgesic effect of using opioids and NSAIDs together is stronger than the effect of each drug alone. The main adverse effects of NSAIDs occur in the kidney or gastrointestinal tract. Such as indigestion, heartburn, nausea, vomiting, poor appetite, diarrhea, constipation, abdominal pain, etc. They can also cause serious reactions such as bleeding, ulcers and perforation in the gastrointestinal tract. In general, it should be used with caution in patients with gastric and renal diseases, thrombocytopenia and allergic susceptibility. Monitor liver and kidney function during drug therapy with NSAIDs. The risk of NSAIDs-induced renal dysfunction is greater in elderly patients with renal insufficiency, heart failure, hepatic insufficiency, hypovolemia, and in patients with other drugs with nephrotoxicity, such as diuretics, angiotensin II drugs, or catecholamines. In addition, patients who are undergoing radiotherapy, potential reduction of platelets or bleeding should not choose this class of drugs. 2. Opioids: Opioids are the mainstay of treatment for moderate to severe pain. Although there are various pharmacological and non-pharmacological treatments for cancer pain, opioid analgesics are essential in cancer pain treatment among all pain treatment methods. According to the length of half-life, opioid drugs are divided into two categories: short half-life with 3-4 hours of action, such as morphine, dihydromorphone, codeine, pethidine; long half-life with 8-12 hours of action, such as extended-release morphine tablets, extended-release oxycodone, transdermal fentanyl patch with up to 72 hours of action; according to the effect of pain relief is divided into two categories: weak opioid, used for mild and moderate pain, such as codeine, chimantin; strong opioid, used for moderate and severe pain; strong opioid, used for moderate and severe pain. opioids, used for moderate and severe pain, such as morphine, methadone, fentanyl, etc. It is quite important to deal with adverse reactions to opioids: 1, the most common adverse reaction to opioids is constipation, the preventive use of laxatives, such as senna, hemp pills, lactulose, etc.; 2, nausea, vomiting often appear in the first week of the start of medication, can be given in a timely manner, such as gastric reversion, morphine, etc., a week or two after tolerance, the symptoms disappear, you can stop using antiemetic drugs; 3, sedation, drowsiness often occurs in opioids Initial treatment or a substantial increase in dose, such as continued drowsiness, appropriate dose reduction; 4, rare respiratory depression, starting with small doses gradually increase the dose of opioids, respiratory depression rarely occurs, occasionally respiratory depression occurs, the use of naloxone 0.2-0.4mg intravenous injection can immediately lift respiratory depression. 5. Treatment with opioids can lead to opioid resistance and physical dependence, which should not be confused with psychiatric dependence (commonly known as “addiction”). The concept of opioid resistance is that in order to maintain the analgesic effect, it is necessary to continuously increase the dose of the drug. The initial manifestation of resistance in patients is a shortened or unsatisfactory duration of analgesic action for a given dose. In fact, most patients require increased analgesic medication due to disease progression and increased pain, rather than the development of drug resistance. Physiologic dependence on opioids is a normal pharmacologic phenomenon that generally occurs when opioids are discontinued or when naloxone is taken concurrently. Symptoms include anxiety, arthralgia, tearing, runny eyes, sweating, nausea, vomiting, abdominal cramps and diarrhea, and other withdrawal syndromes. When the patient’s pain is relieved, the opioid can be reduced or discontinued. To avoid withdrawal syndrome, use 50-75% of the previous day’s dose every day for the first 2 days of discontinuation, and then reduce the dose by 25% every 2 days until the total daily dose is 10%, and discontinue the drug after 2 days. 3.Rational selection of adjuvant drugs: Adjuvant drugs are used to enhance the effect of pain relief. In the treatment of special types of pain, adjuvant drugs can produce independent pain relief effects, such as anticonvulsants are effective for gunshot-like pain, amitriptyline is effective for superficial burning pain, corticosteroids are effective for pain caused by intracranial hypertension, bone metastases, hepatic peritoneal dilatation, etc. Anxiolytics and antidepressants can improve pain in anxious patients. What are other pain relief methods? 1.Acupuncture, external application of Chinese medicine, other physical therapy. 2.Radiotherapy for pain relief: radiotherapy for bone metastases has better effect on pain relief. For headache and low back pain caused by cancer infiltration or compression of nerves, radiotherapy also has certain efficacy. 3.Psychotherapy: all patients with cancer pain have some degree of psychological problems. Psychological intervention and health guidance can help.