According to statistics, about 50% of all cancer patients and 70 to 90% of advanced cancer patients have pain problems. Most of the non-cancer patients may experience only acute pain or mild pain, so general non-steroidal anti-inflammatory drugs are often sufficient to suppress; and because of this, people are “painkillers”. Cognition often stays in non-steroidal painkillers.
However, for cancer patients, pain is the most common symptom. Non-steroidal painkillers purchased using these general pharmacies often have deficiencies. Therefore, in order to treat cancer patients with chronic moderate to severe pain, the cancer pain guidelines in various countries have listed opioid painkillers as the primary drugs for cancer patients to relieve pain.
Cancer pain treatment principle
The types of pain can be mainly distinguished into somatic pain, visceral pain, and neuropathic pain.
Among them, somatosensory pain is the pain that most healthy people encounter most of the time. It is the pain of flesh and bones. The somatosensory pain is usually very clearly located. The pain is quite sharp. It has a good response to general non-opioid drugs.
Visceral pain, as the name implies, is the pain caused by damage to the internal organs. Usually, the position is quite vague and difficult to describe clearly. Sometimes it is accompanied by other symptoms such as pale face, sweating, nausea, vomiting, etc. Sometimes the pain is still in place. Will be pulled to other locations, such as inflammation of the gallbladder, sometimes with the upper right back and back; visceral pain response to non-opioid drugs, not as good as somatosensory pain, so often need to use opioids to deal with .
Neuropathic pain is caused by direct injury to the nerves, so it is usually accompanied by symptoms of the nerves. The patient may feel the feelings of tingling, numbness, itching, and burning. The neuropathic pain responds to any type of painkiller. Both are worse than somatosensory pain and visceral pain, so it is often necessary to add adjuvant drugs or even non-drug treatment.
However, the pain status of cancer patients is very complicated, usually there is not only one part, or one type of pain, often the pain caused by a mixture of somatosensory pain, visceral pain and neuropathic pain. Coupled with the fact that cancer pain is usually high, non-opioids are not sufficient to suppress. Therefore, opioids play a pivotal role in cancer pain control. In recent years, the guidelines for the treatment of cancer pain in Europe and the United States have no longer emphasized or directly abandoned the concept of the “pain ladder” proposed by the World Health Organization (WHO) in 1986, and are no longer limited to the use of opioids in cancer pain, others. Opioids can also be considered for non-cancer pains above and below moderate to severe.
Therefore, for physicians who are familiar with the use of analgesics, after examining the painful condition of the patient, as long as the cancer patient has an analgesic need, the opioid analgesic or even the potent opioid analgesic can be used directly.
Ideal cancer pain control
According to the Health Insurance Agency, half of all cancer patients in Taiwan have pain problems. The biggest difference between the treatment of cancer pain and the pain treatment that most people understand is that cancer pain is usually chronic pain. Unlike most of us suffering from injuries or acute illnesses, most of the time it is less than a month of acute pain. Many cancer patients can experience chronic pain for more than three to six months.
Therefore, the goal of treating cancer pain is to “control pain as much as possible”, rather than waiting until the pain occurs. However, there are indeed cancers in the patients who are making waves. We need to maintain the concentration of opioid analgesics in the blood of patients, so that opioid analgesics can improve the pain threshold of patients to reduce the sensitivity of pain. This way, even if the cancer continues to blame, the patient will not always hurt.
Side effects of opioid painkillers
Many people think that opioid painkillers are associated with many side effects. When they see nausea, vomiting, constipation, dysuria, respiratory depression, etc., they may treat these drugs as poisons after the possible side effects of nearly ten opioid painkillers. . In fact, many of the side effects listed on the medicine bags are not very high, and they are not necessarily present. As long as you pay attention to the dose adjustment, these drugs are very safe.
The side effects of general opioids occur several times before, even the first time they are used, so many patients who do not understand the characteristics of opioids are often scared when they first use them. However, the side effects of opioid analgesics are almost always tolerated (except for constipation and dilated pupils). As long as the patient is assisted in the discomfort of the previous few days, these side effects will be reduced or even disappear after five to seven days. At the time, the body has also adapted to the drug, and long-term use is not a common dangerous side effect, nor will it hurt the stomach, hurt the kidney or hurt the liver. Therefore, as long as it can last for a week, basically “head over, body over”, long-term use of opioid painkillers in accordance with the doctor’s advice, but much safer than long-term use of non-steroidal painkillers.
In addition to side effects, many people associate with addiction. In fact, opioids approved by health authorities and recommended by pain control guidelines are extremely addictive when used in cancer pain relief. Cancer patients take opioid painkillers for cancer pain, and the chance of addiction is less than five-thousandths.
Those who use opioid analgesics must have three conditions: one is cancer patients themselves; the other is non-drug abusers; third, they must follow the doctor’s advice. Therefore, because opioid painkillers are distant relatives of heroin, they have overturned a boatman and overturned the importance and benefits of opioid painkillers for cancer patients.
There are many types of painkillers
Painkillers can be classified into “non-opioid painkillers”, “weakly opioid analgesics” and “potent opioid analgesics”.
The so-called non-opioid painkillers are commonly heard, aspirin, prasin, and muscles that can be bought by the pharmacy. These drugs are most often labeled as “components do not contain steroids.” Non-steroidal analgesics are mostly used for somatosensory pain. For cancer patients, the analgesic effect is not necessarily sufficient, and there are dose restrictions. After long-term use, it will significantly increase the risk of gastric ulcer, gastrointestinal bleeding, and may lead to impaired kidney function. , the heart function is reduced, etc., the side effects can not be underestimated.
“Awesome opioid analgesics” and “potent opioid analgesics” have morphine-like chemicals in their ingredients. The main use is analgesia. The effect of the potent analgesic has no ceiling effect, that is, the higher the dose, the stronger the analgesic effect, and there is no absolute maximum dose. For cancer patients with severe pain, these potent opioid analgesics can continue to be dosed in order to achieve pain relief after a slow dose adjustment process, if there is no serious side effects and persistence of pain.