According to the World Health Organization (WHO), 30% to 50% of new cancer patients around the world have different degrees of pain each year, and the results of this survey in China are as high as 51% to 61.6%. Among the surveyed cancer pain patients, 80% of them are most afraid of pain rather than death. On the other hand, the misconceptions of some doctors and patients about pain treatment also affect the timely treatment of the disease.
Myth 1: Fear of opioids and belief that non-opioid drugs are safer.
For patients who need long-term pain medication for chronic cancer pain, it is safer and more effective to use opioids. The side effects of non-opioids are easy to ignore, such as irreversible side effects on digestive system, urinary system, blood system and central nervous system, etc. Moreover, their analgesic effect has a “capping effect”, so for patients with moderate to severe cancer pain, opioid painkillers have an irreplaceable position.
Myth 2: Painkillers should be applied only when the pain is unbearable.
In fact, the two most important concepts in the basic principles of three-step pain relief are “on-time” and “step-by-step” dosing. If the patient’s pain is not relieved or even worsens during the treatment, the single dose should be increased,
The number of doses should not be increased. It is safer and more effective for patients with cancer pain to take pain medication on time, which can achieve continuous and effective pain relief,
It is safer and more effective for patients with cancer pain to receive timely and timely pain medication, which can provide continuous and effective pain relief with the lowest intensity and dose. Patients without long-term pain relief are prone to anxiety and difficulty in sleeping and eating, which affects their quality of life, and the resulting wasting and exhaustion make them unable to tolerate primary treatment (such as surgery, radiotherapy and chemotherapy),
It is easy to develop nociceptive allergy, abnormal pain and other intractable pain.
Myth 3: The nerves that cause cancer pain cannot be destroyed, and once destroyed, it will lead to limb paralysis.
There are many types of nerves that cause cancer pain. In addition to the spinal nerves that govern the movement of limbs, the sympathetic nerves in the cervical, thoracic and lumbar areas of the body, the visceral nerves that govern various organs, the spinal nerves in the thorax and abdomen, and the trigeminal nerves in the head and face can be destroyed by physical or chemical means.
With the high development of modern imaging technology, the destruction of various nerves can be guided by CT, MRI, ultrasound and other equipment, which greatly improves the accuracy and efficiency. Therefore, after destroying these nerves, not only will it not cause functional disorders of related tissues and organs, but also can effectively relieve all kinds of intractable cancer pain and greatly reduce the dose of opioid drugs, while minimizing the adverse effects of various drugs. It can also greatly reduce the dose of opioid drugs and minimize the adverse effects of various drugs.
Myth 4: Opioid drugs are very addictive.
According to clinical practice, addiction to opioids is extremely rare in cancer pain patients under standardized use.
In terms of addiction, when the injurious stimulus of pain travels up the neural pathway that transmits pain, the pain patient’s body generates special opioid receptors that are scattered among the existing opioids, dispersing the pain-relieving drugs that enter the body, and these special receptors do not exist in individuals without pain, so most of any opioid that enters the body binds directly to the receptors in the brain, causing a sudden increase in opioid concentrations in the brain, increasing the likelihood of addiction.
In addition, the incidence of addiction is related to the method of drug administration, and the sudden increase in blood concentration due to direct intravenous injection can easily lead to addiction. Controlled-release formulations of opioids are mostly used in cancer pain treatment, and this is rare. Experimental studies and clinical practice have confirmed that addiction rarely occurs when opioids or transdermal patches are taken orally by cancer pain patients, and once opioids are used, opioids can be safely discontinued at any time if the cause of cancer pain is controlled and the pain disappears.
This phenomenon of “physical dependence” on drugs should be distinguished from the so-called “addiction”, but the use of opioids for non-medical purposes is drug abuse. The use of opioids for non-medical purposes is drug abuse, such as repeated intravenous injection of large doses of opioids may lead to “addiction”.
Myth 5: The use of dulcolax is the safest and most effective painkiller.
In the field of cancer pain treatment, pethidine hydrochloride, a synthetic strong opioid, has long been recommended by the state not to be used for chronic cancer pain patients. Since pethidine hydrochloride metabolite in vivo is a toxic metabolite, it excites the central nervous system and can cause systemic convulsions, and has a long half-life, so it is easy to accumulate poisoning in the body with long-term use. At present, the ratio of opioids to pethidine hydrochloride is an international indicator to measure the level of analgesia in a country, and pethidine hydrochloride is no longer used as an analgesic for cancer pain in China.
Myth 6: Opioids will be rapidly tolerated, and patients will require more and more drugs and will not be able to stop taking them.
Tolerance is a phenomenon in which the analgesic effect decreases with long-term use of an analgesic drug and the dose and/or number of doses need to be increased to maintain the original effect. Some tolerance occurs with the prolonged use of opioids, so that the dose of the drug needs to be increased, but the drug does not lose its effect. Clinical studies have shown that the increase in dose in cancer pain patients is often related to the progression of the disease and is the result of increased pain intensity, especially in patients with advanced cancer pain.
Most of the tolerance problems are caused by inappropriate dosing methods, which allow pain to recur due to irregular dosing intervals, so that the dose needs to be increased to produce effective analgesia.
Myth 7: Opioids have serious side effects, even leading to respiratory depression, and should be discontinued immediately.
In fact, in addition to the side effects of constipation, most of the adverse reactions of opioids are temporary or tolerable, nausea and vomiting and other reactions will generally disappear on their own after a few days, therefore, the use of opioids when nausea and vomiting and other adverse reactions do not need to immediately stop the drug, if necessary, can be used to treat opioid-induced nausea and vomiting, such as flupredinol, gastric complex. Preventive measures for constipation include drinking more water, eating more fibrous food, appropriate activities, etc. Therapeutic measures include the use of laxatives, enemas, etc.
Also, for patients with respiratory distress, small doses of opioids can significantly improve the patient’s symptoms. Any inadvertent overdose can be reversed by injecting naloxone, which can be dealt with in a timely manner by careful observation during the administration of the drug. Of course, opioids are highly toxic and narcotic drugs, which must be strictly managed and used reasonably and legally in accordance with the relevant legal system, and not abused.
Myth 8: Taking opioid drugs for cancer patients will shorten their life span.
One of the reasons why domestic cancer pain treatment is not adequate is the fear that the application of opioid drugs in large doses will shorten the survival time of patients. Foreign data show that the correct application of opioids instead prolongs the life of cancer patients due to the disappearance of pain, improved sleep, enhanced appetite and physical fitness, however, it is worth noting that although many clinical studies have proved that opioid doses have a strong clinical safety range;
The correct and rational application of opioids for the treatment of moderate to severe cancer pain is a safe and effective method that does not shorten the survival time of patients and helps to reduce their pain and improve their quality of life, but the available evidence is still insufficient because no relevant randomized controlled trials have been conducted. The differences in pain levels and the ethical issues of placebo use make it difficult to apply the principle of randomization to the selection of drugs, making randomization to groups difficult.
Therefore, further research and discussion are needed on how to effectively address the challenges in research and more objectively reflect the effects of opioids on survival time of patients with cancer pain.
Myth 9: Since opioids are applied, there should be no pain.
The pain of cancer patients is complicated and can be divided into four types according to the causes.
1. 78.2% of the pain is directly caused by tumor invasion;
2.Tumor related but not directly caused by tumor accounts for 6%;
3.Tumor treatment causes 8.2%;
4.Pain not related to tumor accounted for 7.2%, 6.7% of patients were caused by two or more reasons.
Here, we cannot ignore that some patients’ own factors may also cause or aggravate the pain, such as patients’ sensitivity, anxiety, as well as disappointment and fear before the end of life may lead to lower pain threshold, etc.
Myth 10: Painkillers cannot be combined with other drugs.
Cancer pain patients are often accompanied by somatic symptoms, such as fatigue, insomnia, gastrointestinal symptoms, neurological symptoms, anxiety and fear, depression and loneliness, etc. While relieving pain, some sedative drugs can be taken to relieve the symptoms. 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.
In cancer pain treatment, the combination of adjuvant drugs is very necessary. Since most analgesics have obvious side effects, adjuvant drugs should be used at the beginning of treatment to reduce patients’ pain and increase the compliance of taking medication. Patients who use opioid drugs for a long time will have constipation due to the inhibition of intestinal peristalsis, so it is necessary to use the combination of drugs for constipation, such as marijuana pills, at the beginning of the treatment, and stronger laxatives can be used in severe cases; opioid drugs also cause vomiting in patients, so the simultaneous use of antiemetic drugs is also necessary.
Haloperidol is a strong sedative, which is good for relieving opioid-induced vomiting, and is also helpful for relieving the agitation of cancer pain patients; respiratory depression is also an acute adverse effect of opioids, which is not important for advanced cancer pain patients who have been using opioids for a long time, but the monitoring of adverse effects after the first use of opioids should be strengthened for initial users. The opioid receptor antagonist naloxone can relieve respiratory depression and other adverse reactions more effectively, but attention should also be paid to the dosage of opioids.
Modern medical treatment means can completely control cancer pain effectively, and medication in strict accordance with the three-step principle can relieve the pain of 80% of cancer pain patients, therefore, cancer patients should be actively encouraged to speak up about cancer pain and cooperate with doctors for cancer pain treatment.
The effective control of cancer pain can not only enhance the effect of tumor treatment, improve the quality of life of patients and prolong the survival period, but also be able to treat cancer under pain-free conditions, defeat cancer and improve the survival quality of cancer patients as a social issue. In small and medium-sized cities and even rural areas, it is of profound practical significance to promote the correct concept of cancer pain treatment and scientific drug treatment for cancer pain.