The clinical manifestations of kidney cancer are diverse, with early clinical manifestations lacking specificity, and only 10% of patients may present with “visual hematuria, abdominal mass, and back pain” (the “triad of kidney cancer”). The majority of patients with the “triad of symptoms” are already in the mid- to late-stage.
Why does kidney cancer cause pain?
Why does kidney cancer cause pain?
The following factors may be considered for pain in kidney cancer:
- The enlargement of the kidney cancer mass and the swelling of the kidney peritoneum, which is often a “dull pain”
- The pain caused by kidney cancer invading the surrounding organs and lumbar muscles is relatively severe and persistent, or “colic” if a blood clot blocks the ureter;
- The pain at the metastatic site of kidney cancer, such as bone pain caused by osteolytic destruction of tumor in bone metastasis of kidney cancer, also arouses patients’ attention enough to seek medical examination when the pain appears, so as to detect kidney cancer.
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How to treat the pain caused by kidney cancer?
For patients with severe pain symptoms caused by advanced kidney cancer, palliative nephrectomy and renal artery embolization can be chosen to relieve symptoms and improve survival quality; palliative radiotherapy can also achieve the purpose of relieving pain and movement disorders, avoiding pathological fractures and improving survival quality; Chinese medicine can also relieve pain by applying ice chips, musk and raw nanxing to the kidney area in a paste made of powder.
The pharmacological treatment of kidney cancer pain must be tailored to the individual. New pain at different stages of treatment and at different points in treatment should be evaluated and the treatment plan should be adjusted in a timely manner, and a stepwise analgesic program is now mainly adopted.
There are three major classes of drugs used to treat cancer pain:
- Non-steroidal anti-inflammatory drugs, or general analgesics, including common pain medications such as fen-phen, aspirin, paracetamol, and diclofenac.
- Opioids, which are narcotic analgesics, include morphine, fentanyl, and others.
- Adjunctive analgesics, sedatives, and nerve-nourishing drugs that enhance the efficacy of analgesics and improve the patient’s subjective sensation and sleep, such as carbamazepine, Valium, etc.
The above three categories of drugs have their own advantages and disadvantages. In order to apply the above drugs rationally and minimize the occurrence of side effects, the World Health Organization has developed a three-step treatment protocol for cancer pain applying the above drugs. The so-called three-step approach is to divide the above analgesics into three categories according to their analgesic strength, and to apply them from low to high level and from small to high doses according to the degree of pain, so that all kinds of pain can be effectively controlled and the side effects on the patient’s body can be minimized.
First-order analgesic regimens
The main drugs in this category are nonsteroidal anti-inflammatory analgesics, such as fenbid, aspirin, diclofenac sodium, and ciloleucine, etc. The main effects of these drugs are analgesic, anti-inflammatory, antipyretic, and anti-thrombotic, and can be used for the treatment of mild cancer pain. However, these drugs have mild to severe gastrointestinal side effects and have limited analgesic effects, and should be applied under the guidance of a pain management physician.
Second-step analgesic regimen
The second-step analgesic for cancer pain is a weak opioid. Moderate cancer pain is often persistent, the patient’s sleep has been disturbed, and appetite has been reduced, requiring the use of a weak opioid, which here includes tramadol, codeine, pentazocine, etc.
Third-step analgesic regimen
Severe or unbearable intense cancer pain can cause severe disruption of sleep and diet, with difficulty sleeping and increased pain at night. The use of general analgesic drugs is basically ineffective at this time, and strong opioid analgesics are needed, which include morphine, dulcolax, fentanyl, etc.
These drugs have a reliable analgesic effect, and increasing doses can increase the analgesic effect, but they all have similar side effects:
- Physiological dependence and tolerance: After a period of continuous use of the drug, withdrawal symptoms can occur when the drug is suddenly stopped. Tolerance is the decrease in efficacy and shortening of duration of action after repeated use, when a gradual increase in dose or shortening of dosing time is required to maintain its efficacy. Both of these phenomena are normal pharmacological phenomena of opioid use and do not affect the continued use of the drug.
- Psychological Dependence: This is known as addiction, where the patient often craves the drug uncontrollably and by any means necessary. The patient’s family and the patient are often too concerned about addiction to apply the dose of analgesic actually needed, but clinical experience has shown that the application of opioids for cancer pain and the development of psychological dependence is rare, and the experience of drug users should not be equated with the application of morphine for pain in cancer patients.
- Neuralgia is resistant to opioids, and antiepileptic drugs such as carbamazepine should be used in combination to treat nerve pain caused by tumor invasion.
The main side effects of opioids are constipation, itching, urinary retention, dizziness, drowsiness, and depressed breathing, etc. Reasonable and strictly prescribed use of these drugs will reduce the side effects.