When it comes to cancer, especially solid tumors, there is often a folk saying, “This disease is pain.” Indeed, cancer pain is a problem that torments millions of cancer patients. Some data show that about millions of tumor patients in China suffer from cancer pain every day, more so in the late stage, of which 30% to 45% are in severe pain, and many of them are in pain. As an oncologist, Trudeau’s famous quote “Sometimes to heal, often to help, always to comfort” has always been my motto. Cancer may still have a long way to go, but even a limited life should have quality and dignity. The International Academy of Pain decided to designate October 11 as World Analgesia Day starting in 2004, and the NCCN (National Comprehensive Cancer Network) has developed analgesia guidelines specifically for adults with cancer pain, which are updated annually. Next, I will share with you the NCCN Guidelines for Adult Cancer Pain that I have translated and organized in my public post! So, what is it that makes so many cancer patients still suffering from cancer pain? In my clinical practice, I have encountered the following situations: 1. The concept of “avoidance” and “pain tolerance”. Some patients and their family members think that pain is a sign of deterioration of cancer condition, adopt the psychological state of avoidance to deal with the emergence of pain, and self-deny the existence or intensity of pain, so that there is a discrepancy between the evaluation of pain and the actual intensity of pain, which leads to the insufficient dosage of painkillers. In fact, this statement is not accurate. The severity of cancer pain is also related to the exact location of cancer cell invasion. If the nerves are invaded, the pain is often more pronounced. If other parts of the body are invaded, the pain may not be obvious even though the condition is aggravated. 2. Use painkillers only when the pain is severe. In fact, timely and on-time use of painkillers is safer and more effective, and requires a lower dose. Patients who do not get pain relief for a long time are prone to anxiety and sleeplessness, which affects the quality of survival, and the resulting wasting and exhaustion make them unable to tolerate surgery and radiotherapy and chemotherapy for the original disease. 3, pain relievers can make the pain partially relieved can. The purpose of applying painkillers is to relieve pain and improve the quality of life. Painless sleep is the minimum requirement for pain relief, and in addition to achieving this goal, ideal pain relief should also strive to achieve the goal of pain-free rest and pain-free activities, so as to improve the quality of life in a real sense. 4. It is believed that the use of non-opioid drugs is safer. For people with chronic cancer pain who need to use painkillers for a long time, the use of opioids such as morphine is safer and more effective. Adverse effects of non-opioids are easily overlooked, such as gastrointestinal symptoms, liver and kidney toxicity, and bleeding risk. Its effect also has a “capping effect” (i.e., ceiling effect: when the drug reaches a certain dose, its pain-relieving effect reaches its peak, and at this time then take a larger dose of similar drugs, the pain-relieving effect will not be increased), for patients with moderate or severe cancer pain, opioid painkillers have an irreplaceable position. 5, into the terminal stage of cancer before using high-dose opioid painkillers. The dose of opioid painkillers has large individual differences, and a few patients need larger doses for pain relief. The dose of opioid painkillers is not capped, and if the pain worsens, the dose of the medication can be increased to improve pain relief. And for any patients with severe pain, if pain relief is needed, large doses of opioid painkillers can be used to achieve the desired pain relief effect. 6, The safest and most effective painkiller is Dulcolax. In reality, the World Health Organization has listed Dulcolax as a non-recommended drug for curbing cancer pain due to its high toxicity and poor pain relief effect. 7, opioids have too many adverse reactions, adverse reactions to stop using. Most of the pain medications stimulate gastrointestinal mucosa, inhibit gastrointestinal peristalsis, stool drying and other side effects, but with some gastric mucosal protective agents, gastrointestinal power drugs and laxatives, it is possible to relieve. Except for constipation, most adverse effects of opioids are temporary or tolerable. Vomiting and sedation that occur with opioids usually only occur during the first few days of medication, and symptoms tend to disappear on their own after a few days. Therefore, at the beginning of cancer pain treatment, the role of auxiliary drugs should be emphasized. 8. Morphine is easy to be addicted and may need to be used for life. The correct viewpoint is: for cancer pain patients, the key issue at this time is not whether they can become addicted to morphine or not, but effective pain relief, so that their quality of life can be improved. And in fact, because of the pain, cancer patients do not experience euphoria during the application of morphine, which is now classified as a regular pain medication. Both pilot studies and clinical practice confirm that cancer pain patients who take morphine orally or apply transdermal patches are rarely addicted. Once opioids are used, they can be safely discontinued at any time if the cause of cancer pain is controlled and the pain disappears. Long-term use of opioid painkillers in cancer pain patients may require a gradual increase in dosage, which can be successfully withdrawn when the pain is relieved, and this phenomenon of “physical dependence” on drugs should be distinguished from the so-called “addiction”. 9. Insufficient understanding of the use of painkillers, the use of drugs after pain or irregular use of drugs. Short-acting drugs should be taken on time, aspirin, paracetamol, ibuprofen, codeine, prednisolone, tramadol, morphine tablets, etc. are short-acting, usually 3 to 4 hours to take a drug, and long-acting drugs can be used once every 12 hours. In recent years, the application of slow-release or controlled-release technology can make the active ingredients of the drug released slowly, and the efficacy is more long-lasting. Such as the first step of the fenbid, Yi Shi Ding, the second step of the chimandine, bicuculline, the third step of the mepivacaine, mexicalcine, etc., the effect of these drugs can generally maintain the time of about 12 hours. 10.After using the high ladder painkillers, you can no longer use the low ladder drugs. Correct point of view: the mechanism of each ladder drug is different, and high ladder drugs cannot block all the pathways of pain caused by tumors, so the drugs of the second and first ladder or the third and first ladder often need to be applied jointly in order to play their proper roles. 11. Some medical personnel, lack of knowledge of standardized diagnosis and treatment of cancer pain, or substandard evaluation of pain, or insufficient dosage of drug administration. It is necessary to strengthen the training of medical personnel themselves, and regard accurate assessment of pain as a prerequisite for rational and effective pain relief. Routine, quantitative, comprehensive and dynamic assessment of cancer pain should be emphasized. 12. Patients or their families worry that the cost of medication is beyond their ability to pay. Painkillers are routine medications in oncology, and most of them are within the scope of medical insurance reimbursement, so there should not be excessive worry about this. In addition, the country is continuously expanding the coverage of medical insurance, and more and more patients are expected to receive timely and standardized treatment in recent years. 13. Neglecting the timely treatment of psychological problems. Most of the cancer patients suffer from cancer pain for a long time, and many of them are hit mentally, eventually accompanied by mental symptoms such as depression, anxiety and irritability, which are either mild or serious. Oral administration of Valium, Xylazine, Amitriptyline, Doxepin, Prozac, etc. while relieving pain has the effect of calming and improving mood, and also reduces the dosage of pain medication, and regulates the mental state of the patient, improves sleep and enhances the quality of life. 14, narcotic drugs management “too strict”, or the supply of drugs involving anesthesia is insufficient. Cancer patients in the late stage will often be transferred to the primary hospital treatment, or in accordance with local customs and habits at home to receive care. China’s consumption of morphine painkillers for cancer patients is far lower than that of developed countries. Many anesthesia and opioid analgesic drugs need to be prescribed only in hospitals, injections cannot be taken out of hospitals, there is a limited amount of oral medicines and patches to be taken out of hospitals, and outpatient prescriptions need to be handled with poison and anesthesia cards. Patients and their families do not know enough about the process, or the location of the patient is far away from the hospital and the transportation is inconvenient, and it is difficult for cancer pain patients to obtain medicines after discharge from the hospital. 15. Insufficient knowledge of analgesic means. In addition to oral or intravenous drugs, there are various means of analgesia such as nerve block, intravenous analgesic pump and subarachnoid analgesic pump, local treatments such as ablation and radiotherapy, drugs to inhibit bone destruction, and auxiliary sedative drugs. In addition to the treatment of the tumor itself, individualized comprehensive treatment should be emphasized on the basis of standardization. For example, for severe bone pain caused by bone metastasis of malignant tumors, the clinic often chooses to combine opioid analgesics with non-steroidal anti-inflammatory drugs. For patients with bone pain accompanied by neuropathic pain, especially those with nerve root injury, at the same time of using painkillers, it should be routinely combined with the application of anticonvulsant or tricyclic antidepressant and other adjuvant drugs, supplemented with imaging such as CT or ultrasound-guided minimally invasive interventional techniques, particle implantation techniques and radiotherapy and other means when necessary. For oncologists, we should always remind ourselves that anti-tumor treatment is not our only task, and it is our responsibility to make patients as comfortable as possible during the treatment process, and if we ignore the latter, we cannot be considered as qualified even if we do the former well. I remember one of my patients who suffered from advanced cholangiocellular carcinoma said this, “Human life is not only length, but also width, while there is light, not to lament the impermanence of life, to sing the hymn of life!” Although she has gone, her words always remain in my heart. At the same time, we also hope that the media and the whole society can participate together, using public service announcements, popular science columns and other forms to enhance the health awareness of the whole population and actively promote the concept of civilized analgesia.