1.Don’t say it again —Dulcolax First of all, let me tell you a story: a 75-year-old patient with extensive metastasis of prostate cancer was treated with dulcolax for pain relief, which was injected intramuscularly every 1 to 2 hours, and his buttocks and arms were covered with needle eyes, so that the nurse could not inject. The patient came to the hospital, and after endocrine therapy and oral morphine analgesia, his pain was reduced, his physical condition improved, and he was able to go out on his own two months later. For a long time, the most commonly used treatment for cancer pain is injection of dulcolax, and patients and their families regard dulcolax as a killer treatment for cancer pain, which is actually a misconception. Although dulcolax can provide pain relief, it is not ideal, and its pain relief effect is only 1/8-1/10 of morphine, and it is not as effective as morphine for severe pain. And the relief time is not long enough, only 2.5 to 3.5 hours, morphine is 4 to 6 hours. The metabolites in the body have central neurotoxicity, and the accumulation of toxicity is high when applied for a long time. Now the World Health Organization (WHO) has taken the consumption of drugs as a standard to measure the level of cancer pain treatment in a country, the more dulcolax is used and the less morphine is used, the lower the awareness of cancer pain treatment. 2.Out of common misconceptions Myth 1 Patients say: It is not needed for minor pain, but only used when the pain is severe. Doctors say: In fact, it is safer and more effective to use painkillers in time, and the required dose is lower. Patients who do not get pain relief for a long time are prone to anxiety and difficulty in sleeping and eating, which affect the quality of life of patients and may cause wasting and exhaustion, and make patients unable to tolerate the treatment of primary diseases (such as surgery, radiotherapy and chemotherapy). Myth 2 Patients say: Try not to use the most powerful ones, just take a little more of the general drugs that don’t work. Doctors say: For patients who need long-term pain medication for chronic cancer pain, it is safer and more effective to use opioids (such as morphine). The side effects of non-opioid drugs (e.g. peptic ulcers) are easy to ignore, and their effects also have a “capping effect —- ceiling effect”, that is, after the pain medication reaches a certain dose and effect, no matter how to increase the dosing amount, the effect will no longer increase, but only increase the side effects. For patients with moderate or severe cancer pain, opioid painkillers have an irreplaceable position. Myth 3: Patients say: painkillers (needles) are addictive, and if you use them more, you are afraid that they will not work anymore. Doctors say: It is clinically proven that addiction rarely occurs when cancer pain patients take morphine or transdermal patches orally. Once opioids are used, opioids can be safely stopped at any time after the cause of cancer pain is controlled and the pain disappears. Long-term use of opioid painkillers by cancer pain patients may require gradual dose increases, and can be successfully withdrawn when the pain is relieved, which should be distinguished from so-called “addiction”. However, the use of opioids for non-medical purposes is drug abuse, such as repeated intravenous injection of large doses of opioids by drug users may lead to “addiction”, so the state strictly controls the application of pain relief injections for ambulatory patients. Myth 4 Patients say: use painkillers only when they are dying Foreign data show that the correct application of morphine prolongs the life of cancer patients because: (1) pain disappears, (2) sleep is improved, and (3) appetite and physical fitness are enhanced. And the application of opioids is not based on the expected length of life, but on the degree of pain. If cancer pain is not effectively solved, not only the patient’s self-esteem is deprived, but also the continuous pain often causes a series of psychological changes such as despair, restlessness and irritability, which leads to the patient’s increased sensitivity to pain and further deterioration of the disease. 3.Cancer pain and pain relief Cancer pain treatment is not as simple as “taking medicine and giving injections”, it is a scientific, standardized and systematic process. It is a scientific, standardized and systematic process. Through systematic treatment, 80% of the symptoms of cancer pain can be solved. The biggest misunderstanding of cancer pain among patients’ family members is that they look for “secret recipes” and high-priced drugs when cancer pain occurs, or they listen to other people’s introduction about the good analgesic effect of such drugs, so they are busy following the trend to buy them and use them. This kind of approach is not effective in treating patients. There are also many patients who think it is normal to have pain with cancer and choose to suffer in silence, even unwilling to talk to their families. Experts suggest that patients should receive standardized cancer pain treatment at the same time as cancer treatment from the first day of cancer discovery. Cancer pain is just a serious symptom, and its basic treatment principle should be to treat both the symptoms and the root cause, that is, treating cancer pain as the symptom and treating cancer as the root cause, and treating the symptom provides the best condition for treating the root cause, and the two complement each other to achieve better treatment effect. Among various means of cancer pain treatment, drug therapy is the most basic, effective and commonly used method, which has the advantages of effective, rapid action, small risk and reasonable cost, etc. Especially early and mild cancer pain patients should adopt drug therapy. There is a clinical “three-stage therapy” for cancer pain, in which physicians will take different treatment measures according to patients’ pain level. When this pain treatment reaches certain medical standards, such as no pain when sleeping, no more than 3 times a day, no pain in daily activities, etc., the treatment can be stopped. However, at the same time, 10% of cancer pain patients cannot be cured or the treatment effect is not obvious. For example, some patients have bone metastasis; some other patients have too complicated causes, which constitute intractable pain. The treatment effect of such patients is not obvious. According to the survey, tumor patients with obvious cancer pain are twice as likely to suffer from anxiety or depression than those without pain. It can be seen that patients are in a relatively pain-free state through necessary pain relief treatment, thus ensuring normal diet, sleep and activities, which can enhance physical function and confidence in overcoming tumor, and improve the effect of tumor treatment. For advanced cancer patients who have completely lost the chance of tumor treatment, pain relief therapy can obviously relieve patients’ pain and improve their quality of life, so that they can go to the end of life more comfortably. In fact, this is equivalent to a kind of hospice care. 4. Pain medication, given in steps, on time and as needed. (1) Three steps of cancer pain relief program Mild cancer pain is generally tolerable and can lead a normal life and sleep basically undisturbed, and should be treated according to the first step. In principle, oral non-steroidal anti-inflammatory analgesics should be taken. They are commonly used clinically: aspirin, anti-inflammatory pain, naproxen, diclofenac sodium, loxoprofen sodium, etc. Nowadays, various drugs are available in various dosage forms, such as suppositories and slow-release dosage forms, which are effective for a long time, have little side effects and are easy to apply. The type of drugs should be changed frequently during treatment to minimize gastrointestinal complications and adverse reactions. Moderate cancer pain is often persistent, with disturbed sleep and loss of appetite. Patients with this kind of pain need to apply analgesic drugs, but in principle, the principle of gradual transition to the second step should be adopted, that is, while giving non-steroidal anti-inflammatory analgesics, auxiliary tramadol or weak opioid analgesics, such as codeine. Sedatives and hypnotics can be given in the evening. Prednisolone has the advantage of fast onset of action and is suitable for patients with moderate cancer pain. Severe or unbearable severe pain, serious disturbance in sleep and diet, difficulty in falling asleep at night and increased pain. At this time, general analgesics and weak opioid analgesics can no longer play an analgesic role. Severe severe pain should be treated by the second step to the third step of the transition, the regular use of strong opioid analgesics. The World Health Organization recommends morphine as the drug of choice for severe cancer pain mainly for the following reasons: ① Morphine is available in most countries and regions in the world, and it is not expensive. ②It can be administered by various routes, and it can be administered orally for a long time to relieve pain with few complications, and the dose can be increased when it is not effective. When it cannot be given orally, it can be given through rectum, intramuscularly, subcutaneously and intravenously. It has analgesic effect on acute pain, dull pain and visceral pain, can reduce anxiety, tension and other emotional reactions caused by pain, achieve sedation and cause euphoria and fall asleep. The more commonly used oral dosage is Methocarbamol (morphine sulfate extended-release tablets) containing 10 or 30 mg of morphine per tablet, once every 12 hours, the dose depends on the degree of pain, age and previous application of analgesics, subject to complete pain relief for 24h. The tablets should be swallowed whole and not chewed. Adverse effects are mainly nausea, vomiting, constipation and dizziness, and respiratory depression is milder than with regular morphine tablets, but may be longer lasting. Physical dependence may occur, but psychiatric dependence is rare. Newer generation drugs include: OxyContin (oxycodone hydrochloride controlled release tablets), 10 mg orally equivalent to 20 mg of oral morphine. Fentanyl patches: Transdermal patches are characterized by the ability to exert pharmacological effects through the skin at a constant rate with very little skin irritation. After the first application, the effective concentration can be measured in the serum after about 6-12 hours and reaches a relatively stable state in 12-24 hours. Starting with a small dose of 25 μg/h, the patch should be changed every 3 days. The patch should be applied to a hairless, non-irritated and non-radiated (within the radiation field) flat area of the torso or upper arm, clean and dry the skin, and use it immediately after unsealing. Change the patch when renewing the next one. There may be adverse reactions such as dizziness, vomiting, constipation, restlessness, dry mouth, abdominal pain, nausea, stomach upset, difficulty urinating, drowsiness and excessive sweating. Among them, dizziness and nausea are more common. Individual patients have local itching, numbness or rash with the drug, which will disappear soon after removing the patch. (2) The choice of drug administration mode: specific analysis of each case The clinical principle of drug administration is to avoid intramuscular injection if it can be taken orally, and to avoid intravenous injection if it can be injected intramuscularly. Analgesics should also follow this principle, and those that can be taken orally should be taken orally as much as possible. However, it is necessary to analyze the specific situation and be flexible according to the actual situation of the patient. For example, for some acute pain attacks, if patients cannot take oral analgesics, intravenous or intramuscular injection is appropriate, which can rapidly relieve pain and save patients from long time suffering. For those patients with chronic cancer pain, it is not only very inconvenient to administer drugs intravenously or intramuscularly for a long time, but also brings new pain to the patient’s body and the patient’s compliance is not good, so it is better to let the patient take oral analgesics on time. Be sure to use the medication under the guidance of a professional oncologist. 5 points are required: oral, on time, according to a step, and individual differences in medication. Pay attention to specific details. (3) Analgesic treatment for bone metastases Multiple bone metastases of vertebrae and iliac bones can be treated with bone cement infusion curing therapy to prevent pathological fracture; patients with bone metastases can also use pain-relieving radiotherapy, which is fast-acting, with little side effects, and can significantly improve patients’ survival quality. (4) Other methods For patients who cannot be relieved by the above-mentioned drugs, the following methods should be applied in hospital in time, including: ① Continuous epidural injection of analgesic solution, which is suitable for patients with severe cancer pain in hospital, to achieve the effect of economic analgesia and quality analgesia. (2) Intravenous continuous pumping analgesic solution; (3) Peripheral nerve block, nerve destruction intervention and other technical treatments. It can completely realize the purpose of making cancer pain patients pain-free.