In clinical practice, many patients and family members are afraid of talking about cancer pain. Most of the pains in the advanced stage of cancer are painful and even painful enough to make sleep and food difficult and tear the heart and lungs. There are many causes of pain caused by tumor, and it is also very complicated, it can be directly caused by cancer or occur during cancer treatment. However, not all cancer patients will have pain, so there is no need to worry too much about it. What about cancer pain, which all must be endured? Patients mostly take the attitude of tolerating cancer pain as long as they can, and are very resistant to analgesic drugs, which is mainly due to two misconceptions 1. We know that pain will aggravate the mental and psychological burden brought by cancer itself, and research shows that pain and other stressful factors can directly or indirectly suppress the immune function of the body and promote tumor growth and metastasis; cancer pain will have extensive effects on various systems of the body and eventually form a vicious circle of pain. In short, cancer pain will have a wide and far-reaching impact on patients’ physical, psychological, social and interpersonal aspects and overall feeling, thus affecting patients’ quality of life comprehensively. Therefore, cancer pain should be actively suppressed! Analgesics are necessary to improve patients’ quality of life and prolong their survival. Most medical experts believe that cancer pain medications, including opioids such as morphine, are not addictive as long as they are applied reasonably. It has also been proven that the use of opioids in pain, especially in severe pain, does not cause psychological dependence or so-called “addiction”, especially in cancer pain patients. What is the best way to relieve pain? The first step is to conduct a pain assessment: the common assessment methods are verbalratingscale (VAS) and numberratingscales (NRS). In the hospital, the doctor will first grade or score the patient’s own pain experience against the chart below. After assessing the patient’s pain, the doctor will give the appropriate pain medication for rapid analgesia according to the three-step cancer pain management principle. The pain medication for mild pain management (first step) includes non-steroidal anti-inflammatory drugs represented by aspirin. Moderate pain treatment (second step) generally uses if opioids represented by codeine, other than dihydrocodeine, tramadol, etc. For the treatment of moderate to severe pain (third step) strong opioids are mainly used. For example, morphine, oxycodone, methadone, dihydromorphone, and fentanyl. Does severe pain have to be treated with injections to be effective? It is most convenient to take orally, and it is available at home and hospital, and the side effects are relatively small when taken orally. Not all severe pains need to be treated with injections. The next dose should be given before the effect of the previous dose disappears to maintain the effective blood concentration, which can reduce the patient’s unnecessary pain and tolerance. Do opioids have significant side effects? As we mentioned before, cancer pain medications, including opioids such as morphine, are not addictive as long as they are applied properly. However, you need to know the side effects of opioid drugs to know yourself and your opponent, so that you will not lose your battle. The common side effects of opioids include: 1. constipation, seen in almost all patients, the degree of constipation and the opioid dose, can be given senna, marijuana soft capsule treatment or prophylactic administration. 2. nausea and vomiting, the incidence of about 30%, repeatedly given (such as 2-3 days later) opioids, the body can produce tolerance to this reaction, that is, after a few days of medication, this side effect can be reduced or even disappeared. If nausea and vomiting are serious, antiemetic drugs such as gastrofacial, morpholine, etc. can be given and treated symptomatically. 3. sedation and drowsiness can be reduced or even disappeared after 3-5 days in most patients. Pay attention to oral opioids, to take strictly in accordance with medical advice, and do not arbitrarily increase or decrease the dose of drugs and randomly change the time to take drugs. In order to avoid unnecessary and artificial outbreak of pain. Is it only possible to take medication to maintain severe pain? Pain medication is a quick and necessary treatment for severe pain, but it is not the only way to maintain the pain once severe pain has developed. For example, for pain caused by bone metastases, there is another effective means of bone pain control —- radiation therapy. Radiation therapy has particular efficacy in the area of treating pain associated with bone metastases and spinal cord compression. Studies have shown that radiation therapy can relieve pain symptoms in 60-80% of patients. After a few simple sessions of radiotherapy, patients with painful bone metastases are able to achieve a significant improvement in their quality of life. For example, for some neuropathic pain, clinically we have seen many patients with pelvic recurrence after rectal cancer and cervical cancer, the tumor invades and compresses the sacral plexus nerve and causes pain in the perineal area, hip pain and lower limb pain, which is often severe and affects normal life and rest. Most of the recurrent pelvic lesions can be reduced through radiotherapy, and the patients’ pain symptoms can be effectively relieved. The following two CT images are the before and after comparison of radiotherapy for a patient with postoperative pelvic recurrence of rectal cancer. (Before radiotherapy in the right image and after radiotherapy in the left image, the arrow indicates the metastasis of the right lateral lymph node in the pelvis, which basically disappeared after radiotherapy in the left image). In conclusion, cancer pain should and can be treated, and cancer pain is not that terrible!