Cancer pain is a kind of physical, mental, emotional and faith-based torture, which relentlessly deprives people of their dignity, distorts their image and makes them feel that they have no self-worth. The mental and spiritual pain caused by cancer pain is often worse than death. Many tumor patients would think, “If death comes, it is better to die with dignity than to live in such pain.” Indeed, if tumor patients are like Jiao Yulu, who restrained the pain by will alone in the late stage of liver cancer, such a life has no quality and is not in line with the humanitarian spirit of medicine. So, when cancer comes with the shadow of pain, how can we stop cancer pain, maintain the dignity of life, improve the quality of life and rekindle the torch of life like safflower? 1.Cancer pain and treatment are equally important Cancer pain is pain caused by malignant tumor destroying patient’s organism tissues and stimulating nerve endings. Cancer pain has many characteristics, one of which is that it is relatively intense. Patients often describe it as “pain that makes me not want to live” and “pain that is unbearable”; another characteristic of cancer pain is that it is persistent and lasts for a long time, and it is difficult to disappear after appearing and will be constantly present. At present, there are more than 7 million cancer patients in China, with 1.8 million new cancer cases and about 1.6 million deaths every year. Among them, 51%-62% of patients have different degrees of pain, about 40% have mild pain and 60% have moderate or severe pain. In short, almost every cancer patient faces the torture of cancer pain. However, many patients are reluctant or unable to express such a physical condition which seems to be a disease but not a disease. Some patients think that “cancer pain is inevitable, especially in advanced stage, pain is inevitable” and “cancer pain treatment is just taking medicine and injections, there is no good way to deal with it”; others think that too much discussion about pain with doctors will reduce doctors’ time and energy for anti-tumor treatment. Other people think that too much discussion about pain with doctors will reduce doctors’ time and energy for tumor treatment, and that doctors do not like to listen to patients’ complaints about pain and want to be a “good patient”, not to mention the worries of their loved ones. It is under such a specific background that the majority of cancer pain patients do not receive standardized pain relief treatment and suffer from severe pain in silence with “coping treatment” or no treatment at all. The one-sided understanding of cancer pain by patients is closely related to the lagging medical treatment of cancer pain in China, and many medical workers also have one-sided understanding of cancer pain. In addition, for many people who can no longer receive anti-tumor treatment, they simply give up all treatments including cancer pain, so that many patients do not receive effective treatment. It has been proved that strongly tolerating pain not only makes patients feel uncomfortable, but also brings a series of serious effects. For example, nausea and vomiting, loss of appetite, anxiety, fear, depression, reluctance to interact with others, various organism functions are reduced, and activity ability is decreased, such as the percentage of pain among middle and late stage cancer patients is as high as 80%, at this time, patients are very painful and spend their days like years under the torment of pain. Not only does it affect the ability to eat and move around, but even normal physiological functions such as urination and defecation are also restricted, and patients often lose confidence in life and treatment; pain not only obviously affects patients’ quality of life, but also affects the implementation and effect of treatment. The treatment of cancer pain, on the other hand, can not only reduce patients’ pain, but also help improve the quality of life and contribute to the successful completion of anti-cancer treatment. In medicine, although radical anti-cancer treatment itself can control pain, it takes some time for pain relief to show effect. Therefore, before radical anti-cancer treatment takes effect, it is also necessary to actively carry out pain relief treatment so that anti-cancer treatment can be completed successfully. In addition, for patients who have lost the chance of radical anti-cancer treatment, pain relief may be the only acceptable treatment method for some patients, because pain relief treatment may enable tumor patients to survive with cancer for a long time in a pain-free state and fight for treatment time and opportunity. Therefore, treatment of cancer pain is as important as tumor treatment, and the earlier the treatment, the better the effect, and it is better to carry out both simultaneously. At present, with the correct and reasonable application of medical treatment, 90% of cancer pain can be effectively relieved and 75% of advanced cancer pain can be relieved, and the quality of survival can be significantly improved. Therefore, once a tumor patient has pain, please do not hold it back, but go to receive treatment as soon as possible. 2.Treatment of cancer pain “three steps” The treatment of cancer pain is a principled and standardized treatment. Among the various means of cancer pain treatment, drug treatment is the most basic, effective and commonly used method. This is because drug treatment has the advantages of being effective, fast acting, low risk and reasonable cost. At present, an important treatment principle followed at home and abroad is the “three-step” drug treatment program for cancer pain promulgated by the World Health Organization in the 1980s. The so-called three-step treatment for cancer pain is to make a proper assessment of the nature and cause of cancer pain and select different pain medications in the first, second or third step according to the degree and cause of pain. Which is how to assess the pain level of cancer patients? We can use three phrases to determine whether an oncology patient is in pain and the severity of the pain. These three words are: does it hurt, can it be tolerated, and does it affect sleep. Of course, there is a stricter medical grading for cancer pain, and the commonly used grading method is 4 levels, which are 0, 1, 2 and 3. Grade 0: indicates no pain. Grade 1 (mild): indicates that there is pain but it is tolerable and can live a normal life with undisturbed sleep. Grade 2 (moderate): the pain is obvious and unbearable, requiring painkillers, and sleep is disturbed. Grade 3 (severe): pain is severe and unbearable, requiring pain medication, sleep is disturbed, and may be accompanied by passive postures (such as twisting the body or rolling on the floor). The first step of treatment, that is, for patients with mild pain, mainly use antipyretic and analgesic analgesics, the main role of this class of drugs for analgesia, good effect on mild dull pain, does not produce drug resistance, non-addiction; there are also anti-inflammatory, antipyretic, anti-thrombotic effect. The representative drugs are aspirin, paracetamol, fotarine, etc. Drugs should also be changed frequently in the treatment to reduce gastrointestinal complications and adverse reactions. The second step of treatment, i.e. patients with moderate pain, should adopt the principle of gradual transition to the second step of medication, i.e. giving antipyretic analgesic painkillers along with auxiliary opioid analgesics. A weak opioid analgesic plus a non-opioid analgesic plus an adjuvant should be used. Typical drugs are tramadol. Strictly speaking, tramadol is not an opioid, but it can act on opioid receptors and is suitable for moderate pain without developing drug resistance and addiction. For patients with severe cancer pain, general analgesics and weak opioids are no longer satisfactory, so the transition to the third-stage treatment should be made and strong opioids should be used. The commonly used drugs include Methocarbamol (morphine controlled-release tablets), which can be administered anally if it cannot be taken orally. Other strong opioid analgesics include morphine, dulcolax, fentanyl, etc. The third-step treatment of cancer pain should follow a regular “on-time” dosing, while the “on-demand” dosing (e.g., dosing only when pain occurs) is not scientific. In addition, the medication should be used in accordance with the procedures stipulated in the treatment principles, starting from the first step, and the medication should be formulated according to the patient’s specific conditions. It is clinically found that some tumor patients have pain but their general body condition is better. At this time, they are often reluctant to receive analgesic treatment and think that they need to apply analgesics, especially opioid analgesics, only when they reach advanced stage (terminal stage). This thinking is not correct. The correct approach should be to apply various treatments to control pain (including three-step analgesic therapy) as long as there is pain, regardless of the patient’s physical condition and the length of survival. This is because the ‘three-step’ approach to pain management advocated by the International Health Organization is not a panacea. The core of “three-step” therapy is to give different medications according to the degree of mild, moderate and severe pain and the patient’s physical condition. Due to the diverse causes and complex nature of cancer pain, many patients with severe cancer pain in the last stage of clinical practice cannot get rid of pain even if the dose of morphine is increased substantially. Therefore, it is recommended that once cancer pain occurs, patients should be treated actively; a three-step drug treatment plan should be preferred for cancer pain treatment; when pain is intensified, the type and dose of oral painkillers should be adjusted under the guidance of specialists. 3.Opioids, not to be used shyly Opioids can inhibit the conduction of nociception within the central nervous system and increase the pain threshold, so as to achieve analgesic effect. The consumption of opioid painkillers is an important evaluation indicator reflecting whether cancer pain patients in a country and region receive reasonable pain relief treatment. At present, the international indicator measuring the level of analgesia in a country is the ratio of morphine and dulcolax use. There is a special problem in the use of narcotics in China. Because the opioids in analgesics can become drugs, many doctors are afraid to apply narcotics. In addition, patients are afraid of addiction due to long-term application. Therefore, although opioid analgesics are the key analgesic drugs for cancer pain treatment, they are the focus and difficulty in implementing the WHO principles of three-step analgesic treatment for cancer. Global consumption of opioids for the treatment of moderate and severe pain has increased by as much as 2.5 times in the last decade, but is concentrated in European and North American countries, and opioid consumption for cancer pain remains low in many developing countries. In response, the United Nations International Narcotics Control Board once again urged the governments concerned to identify the various barriers affecting the use of opioids for pain treatment in their countries and to take measures to improve their availability for medical purposes. In recent years, China has been commended by the Board. Morphine consumption in China has increased dramatically, from 6.7 kg per year in the late 1980s to over 600 kg per year today, and has come a long way. However, the development of the clinical application of narcotic drugs in China is extremely uneven across regions, and the level of drug use in remote areas is very low. In order to maintain the trend of sustained development in China, much work is still needed. At present, the main factors affecting the consumption of opioids are: (1) Medical personnel have insufficient knowledge and old-fashioned concepts about pain and lack of systematic training, and about 50% of oncology specialists have not received formal training and education on the guidelines of cancer pain relief programs. (2) Although China has always given the green light to the use of narcotics for cancer patients, the implementation of policies in various regions is not resolute, and many regions are not even equipped with the most basic morphine tablets, and even the newly introduced essential drug catalog in China does not have morphine tablets, which directly affects the patients’ medication. (3) Addiction phobia”. It should be clarified that the fact that morphine for pain relief does not make patients addicted. According to the questionnaire survey, about 67% of doctors and patients are worried about morphine addiction and thus suffer from “morphine phobia”. Therefore, although morphine has a good clinical effect on pain relief, both doctors and patients are psychologically resistant to it and try not to use morphine if they can. In fact, there are very few people who are addicted to morphine for cancer pain treatment. The analgesic effect of morphine is not capped, and the analgesic effect can be increased by increasing the dosage. Therefore, even with the progress of cancer and the development of morphine resistance, morphine can still provide good analgesia as long as the dose is increased, which is not addiction. For cancer pain patients, the key is effective pain relief and improved quality of life, not whether it can be addictive. In fact, due to the pain, cancer patients do not experience euphoria during the use of morphine. We must get out of the misconception that morphine is an opiate drug. The drug tolerance and physiological dependence of cancer pain patients due to the use of opioids are different from the pursuit of psychological stimulation by drug addicts, and it is unnecessary to limit the dosage of opioids for advanced cancer patients because of the possibility of addiction, which is not conducive to pain control and improving the quality of life of advanced cancer patients. In conclusion, the whole society should pay attention to cancer pain people, correctly understand cancer pain treatment, and doctors and patients should work together to block pain, so that cancer patients can live a dignified and quality life every day! This is the hope of every one of us.