Three Step Therapy for Cancer Pain

  Pain is one of the main pains faced by patients with middle and advanced cancer, and the incidence rate among middle and advanced cancer patients is as high as 70% to 80%, which seriously affects the treatment and quality of life of patients.  On May 14, 1993, the Ministry of Health of China issued the Guidelines for Three-stage Pain Relief Ladder Therapy for Cancer.  The advantages of oral administration are non-invasive, convenient, safe and economical, while other non-invasive administration methods include transdermal posting, rectal suppository and mucosal administration through the mouth and nose.  2, according to the step of drug use refers to the selection of the corresponding drugs according to the intensity of pain. Mild pain: preferred non-steroidal anti-inflammatory drugs (NSAIDs) (represented by aspirin, the first step) Moderate pain: preferred weak opioids (represented by codeine, the second step) ± NSAIDs ± adjuvant drugs. Severe pain: strong opioids (represented by morphine, third order) ± NSAIDs ± adjuvant drugs are preferred. 3. Timely dosing It refers to the maintenance of smooth and effective blood concentration according to the principle of temporal pharmacology, which is conducive to continuous and effective analgesia and reduction of adverse drug reactions.  4.Individualized drug administration Because of the obvious differences in dosage, efficacy and adverse reactions of anesthetic analgesics among individuals with cancer pain, it is necessary to individualize the selection of drugs and individualize the titration of drug dosage.  Before cancer pain treatment, we should spend some time (15 minutes) to educate patients and family members about cancer pain treatment, including: cancer pain should be relieved in time, opioids will not be “addictive” when used for cancer pain, how to assess the pain level, the effects and adverse effects of pain medication, how to improve medication compliance, etc. The purpose is to monitor the effect of medication and adverse reactions, adjust the dose of medication in time, improve the effect of pain relief treatment and reduce the occurrence of adverse reactions.  In 2005, the State Council Document No. 442, “Regulations on the Administration of Narcotic Drugs and Psychotropic Substances,” states that “for patients who really need to use narcotic drugs or Class I psychotropic substances, their reasonable medication needs should be met. needs.” In 2007, the Ministry of Health’s “Prescription Management Measures” stipulates that a controlled and slow-release preparation of narcotic drugs may be prescribed for outpatients with cancer pain and patients with moderate or severe chronic pain in 15-day quantities per prescription.