Cancer is still a world problem in today’s medical field. Every cancer patient suffers from torment, losing weight and suffering from pain, which makes their loved ones and close friends feel heartbroken. So, although most cancers cannot be cured, what methods do we use to control the pain of cancer patients and improve their quality of life so that they can have a rare smile? Let’s take a look at the international standard of cancer pain treatment.
Three-step treatment plan for cancer pain
When cancer is first diagnosed, about 25% of patients have pain symptoms, about 35% of patients have pain during the anti-cancer treatment period, and the incidence of pain in advanced cancer rises to 75%. Pain is also one of the most fearful symptoms for cancer patients. Pain can seriously affect patients’ mood, sleep, life, mobility, relationship with family and friends, and seriously interfere with patients’ quality of life. Improper treatment of cancer pain is common. For reasonable pain treatment, WHO has formulated the principle of three-step pain treatment for cancer.
More than 90% of cancer patients can have their pain relieved according to the three-step treatment principle, and some of them can improve their quality of survival and prolong their lives because their pain disappears and their confidence in fighting cancer increases.
First of all, please follow 5 basic principles for the treatment of cancer pain.
I. Oral medication
Prefer oral and non-invasive route of drug delivery. Oral medication is non-invasive, convenient, safe and economical. With the progress of research on new dosage forms of painkillers and the different needs of patients for different routes of drug delivery, in addition to oral drug delivery, other non-invasive routes of drug delivery are becoming more and more widely used, such as transdermal patches for pain treatment. If the patient has difficulty in swallowing, severe vomiting or gastrointestinal obstruction, transdermal patches and rectal suppositories can be used. If necessary, use infusion pump for continuous subcutaneous infusion.
Second, medication according to the step
It means that the selection of pain medication should be based on the degree of pain from mild to severe, and the pain medication of different strengths should be selected in order. In other words, the first step of the three-step treatment plan is preferred for mild pain: non-opioid analgesic drugs (non-steroidal anti-inflammatory analgesic drugs); if the pain relief effect is not achieved or the pain continues to increase for moderate pain, anti-inflammatory analgesic drugs plus weak opioid drugs (represented by codeine) are selected, which is the second step; if the pain still cannot be controlled or the pain increases for severe pain, the third step is selected: strong opioid drugs (represented by morphine), and the third step is selected. The latter can not only increase the pain relief effect of opioid drugs, but also reduce the dosage of opioid drugs and reduce drug addiction.
Timely medication
It means that painkillers should be given at regular intervals as prescribed. When using painkillers, the dose that can control the patient’s pain must be measured first, and the next dose should be given before the effect of the previous one disappears, so as to ensure continuous pain relief. Some patients can be given on demand due to sudden onset of severe pain.
IV. Individualized dosing
Due to individual differences, there is no ideal standard dose of opioid drugs, and the dose that can relieve pain is the correct dose.
V. Pay attention to specific details
Patients using painkillers should be supervised and closely observed for the degree of pain relief and physical tolerance, and necessary measures should be taken in time to minimize the adverse effects of drugs and improve the effect of pain treatment.
Let’s focus on the three-step treatment of cancer pain.
First step
Give non-opioid (non-steroidal anti-inflammatory and pain-relieving) drugs for mild pain. Note: There is a problem of maximum effective dose (ceiling effect) of non-steroidal anti-inflammatory analgesics. Commonly used drugs include paracetamol, aspirin, diclofenac, ibuprofen, fenpropathrin (ibuprofen extended-release capsules), anti-inflammatory pain, indomethacin, Isidin (indomethacin controlled-release tablets), nimesulide, etc.
Second step
Weak opioids plus nonsteroidal anti-inflammatory analgesics and adjunctive analgesics are given for moderate pain. Weak opioids also have ceiling effects. Commonly used drugs include codeine, prednisolone, tramadol, chimantin (tramadol extended-release tablets), diclofenac (codeine controlled-release tablets), etc.
Third step
Opioids plus or minus NSAIDs and adjuvant analgesics are given for severe pain. Strong opioids have no ceiling effect, but can produce tolerance and require appropriate dose increases to overcome tolerance. The previous belief that morphine was addictive for pain relief and so patients were reluctant to be given morphine has been proven wrong – very few cancer pain patients using morphine develop addiction. Commonly used drugs on this ladder include morphine tablets, Mefecam (morphine extended-release tablets), and Mescaline (morphine controlled-release tablets that can be administered rectally), among others. However, Dulcolax, a previously used painkiller, is not recommended for the control of chronic pain due to factors such as the high toxicity of its metabolites.