The basic principles of standardized treatment for cancer pain relief are.
1. Use drugs according to the order. It means that the selection of pain medication should be based on the degree of pain from mild to severe, and the pain medication of different strengths should be selected in order, i.e. from weak to strong or from general to tertiary. If the pain is not severe, non-opioid pain medication should be chosen, which belongs to the first step of the three-stage ladder; if the pain relief effect is not achieved or the pain continues to increase, it is elevated to the second stage, and weak opioid medication is added to non-opioid medication; if the pain is still not effectively relieved or the pain continues to increase, it should enter the third stage, and strong opioid medication should be used, and non-opioid medication can be added at the same time, because it can increase the The pain relief effect of opioid drugs can be increased and the dosage of opioid drugs can be reduced. When the pain cannot be relieved by using a pain medication, it must be replaced by a medication with stronger pain relief effect, but not by another medication with similar effect. For patients with special indications such as psychiatric symptoms or psychological disorders, adjuvant drugs should be added.
2.Take medication on time. Only regular use of pain medication at regular intervals can maintain continuous pain relief. Some patients may experience sudden severe pain, and 50% to 100% of the prescribed unit dose of pain medication can be added once on top of the original medication regimen.
3.Orally administered drugs. The medication should be given orally as much as possible so that the patient can use the medication independently without relying on the health care personnel. If the patient has difficulty swallowing, uncontrollable vomiting or gastrointestinal obstruction, rectal suppositories can be used. Patients can also carry an infusion pump for continuous subcutaneous infusion of pain medication.
4.Individualized drug administration. The sensitivity of pain medication varies greatly among individuals, so there is no standard dose of opioid medication. The selection of opioid analgesic drugs should start with a small dose and gradually increase until the patient feels comfortable.
5. Pay attention to specific details. In order to obtain the best efficacy to reduce the occurrence of side effects, the patient’s pain relief degree and body gua in should be closely observed and necessary measures should be taken in time.
Myths of cancer pain treatment
Myth 1: Non-opioid drugs are safer than opioid drugs
Fact: Opioids are safer and more effective for those who need long-term analgesic treatment. Opioids have significant analgesic effect, no capping effect, and long-term use has no effect on gastrointestinal, liver and kidney functions, so they are better than non-opioids in all aspects of clinical application.
Myth 2: Only use analgesics when the pain is severe
Fact: It is safer and more effective to use analgesics in a timely manner and on time, and the strength and dose of analgesics required are also the lowest, which can also avoid intractable pain such as nociceptive allergy and abnormal pain.
Myth 3: Analgesic treatment can provide partial pain relief
Fact: The goal of analgesia is to relieve pain, improve function, and achieve pain-free sleep-pain-free rest-pain-free activity.
Myth 4: If you experience vomiting and sedation with opioids, stop the drug immediately
Fact: Except for constipation, most opioid adverse reactions are temporarily tolerated. You should actively prevent and control adverse reactions and continue opioid analgesic treatment.
Myth 5: The use of pethidine is the safest and most effective analgesic
Fact: WHO has listed pethidine (dulcolax) as not recommended for cancer pain treatment. The analgesic effect of pethidine is only 1/10 of morphine, and the metabolite norethindrone has a long half-life, neurotoxic and nephrotoxic, and the oral utilization rate is low, and the intramuscular injection itself produces pain, so it should not be used for chronic pain treatment.
Myth 6: Only patients with end-stage cancer should use the maximum tolerated opioid dose
Fact: Opioid doses vary greatly among individuals. For any severe pain, regardless of stage and survival, the maximum tolerated opioid dose can be used as long as pain treatment is needed.
Myth 7: Long-term use of opioid analgesics inevitably leads to addiction
Fact: The risk of “addiction” with standardized medication use is extremely low (<4/10,000). Measures to prevent addiction include: education, oral or transdermal administration, use of extended or controlled-release formulations, regular dosing, and avoidance of excessive peak blood levels.
Myth 8: Opioids, if widely used, are bound to cause abuse
Fact: The WHO has implemented the three-step principle for 20 years, and the global opioid medical use has increased significantly, but not the risk of opioid abuse. Therefore, rational use and management of medications can be completely safe and effective in relieving patients’ pain.
Myth #9: Once you use opioids, you may need them for life
Fact: As long as pain is satisfactorily controlled, opioids can be stopped or switched to non-opioid medications at any time. Morphine 30-60mg/d is safe to stop, and can be reduced and stopped if used at high doses for a long time.
Myth #10: Patients should not drive while on opioid therapy Fact: Initial medication affects cognitive/psychomotor coordination and is not suitable for driving. The ability to drive safely can be restored after 5-7 d of continuous medication is tolerated.
Myth #11: Patients on pain medication will not reduce the dose or frequency of use on their own
Fact: Patients who are not “addicted” can try to reduce the dose once the pain is controlled. The use of extended-release agents can reduce the number of doses and make it safer and more convenient.
Myth 12: Giving only long-acting opioids to patients with persistent pain is sufficient
Fact: Long-acting opioids are recommended for continuous analgesia by administration, while short-acting opioids PRN are prepared for relief of sudden onset of pain, and the dose of on-time dosing should be increased for relief dosing > 2-3 times/d.
Myth 13: Opioids inhibit breathing
Fact: The risk of respiratory depression is low with reasonable individualized dosing. Pay attention to monitoring and avoiding excessive peak blood doses at the beginning of opioid dosing.
Myth 14: Opioid dose increases should be reserved
Fact: Adequate doses should be administered for effective and safe pain relief. If the dose is insufficient, the analgesic efficacy will be poor, but lead to increased difficulty in pain treatment.
Myth XV: Intravenous opioids are more effective than oral (transdermal)
Fact: The concentration of drug acting on opioid receptors determines efficacy, not the route of administration. The advantage of intravenous administration is that the first dose has a rapid onset of action and facilitates dose titration. Equivalent doses administered orally (transdermally) are as effective as intravenous and safer.
Myth #16: If a patient requests an increase in opioid dose, it indicates tolerance or addiction
Fact: Most opioid dose increases requested by patients are needed for painful conditions, i.e., mostly for pseudo-tolerance or pseudo-addiction.
Myth #17: Opioids cannot be used to treat neuropathic pain
Fact: Opioids are the basis for the treatment of neuropathic pain, but because of their relatively unsatisfactory efficacy alone, a combination of adjuvants is recommended.