Cancer pain is one of the common symptoms of cancer patients, especially those in the middle and advanced stages. It not only brings physical pain, but also causes the patients to produce anxiety, irritability, depression, grief, despair and other bad emotions. The latter will make the pain further Exacerbate and form a vicious circle. Therefore, to survive painlessly, to improve the quality of life of patients with advanced cancer, and to strengthen humanistic care in the treatment of cancer pain are the goals pursued by doctors and patients. So, what good analgesic methods are there for cancer pain?
We can learn from the example of Mr. Wu.
“Doctor, please give me an injection of euthanasia. I really don’t want to live anymore, it hurts too much…” Old Uncle Wu cried out this sentence. Uncle Wu is a thin patient with advanced lung cancer who has undergone many operations since he was diagnosed a year ago. However, the current tumor treatment ranks second. The top priority is to solve the pain problem and make him suffer less.
Uncle Wu has such a terrible pain, why not give him painkillers? In fact, he had been given commonly used painkillers, such as OxyContin, but Mr. Wu would vomit very badly when he took only 10 mg orally; he would also experience severe nausea and vomiting with fentanyl patches.
For the treatment of cancer pain, the World Health Organization has implemented the “Guiding Principles for Three-Step Analgesic Treatment of Cancer Pain” since 20 years ago, but to date, effective analgesia can only reach 45% to 100%, and it is still difficult to completely relieve cancer pain. Realization; Nausea, vomiting, and constipation are the most common adverse reactions. Cancer patients sometimes cannot tolerate the adverse reactions of opioids, leading to failure or termination of drug treatment. Therefore, in recent years, the concept of “multi-modal analgesia” has been widely praised, and the original “three-step pain therapy” has been modified clinically to “four-step therapy”: (1) non-opioid drugs (NSAIDs); (2) weak Opioids; (3) Strong opioids; (4) Interventional therapy, continuous infusion pump system and neuromodulation methods.
In response to Mr. Wu’s situation, I decided to take the fourth step intrathecal drug infusion therapy. A smart analgesic pump (shaped like a small moon cake) that can store medicines and adjust the flow rate outside the body is implanted into the body, and the analgesic medicine is delivered into the cerebrospinal fluid in the subarachnoid space of the spinal cord through an intrathecal catheter, which directly acts on Pain center to relieve pain. Intrathecal drug infusion therapy has less trauma and good analgesic effect. Compared with oral medication, it requires a small analgesic dose (only 1/100 of intravenous medication and 1/300 of oral medication), small side effects, and convenient for long-term Control pain. Moreover, the doctor can adjust the dosage at any time according to the change of the pain intensity of the patient, so that the patient can obtain the most satisfactory analgesic effect.
“I don’t feel much pain most of the time now, but occasionally I still have a sudden pain, which lasts not long, but the pain is particularly severe.” On the third day after the operation, Mr. Wu told me. This situation is explosive pain, which is a situation that almost all cancer pain patients face. But I have already figured out a coping strategy-give Mr. Wu a “BP machine”. It is actually an external remote control. The patient can administer one-touch medication by himself. The drug can reach the body within 1 minute, and the fastest Control the explosive pain with the smallest dose in time. Since then, Mr. Wu has achieved satisfactory and stable analgesic effects, no severe pain has recurred, sleep has been improved, appetite has improved, and the quality of life has been significantly improved.
Intrathecal drug infusion therapy is currently internationally recognized as an advanced therapy for the treatment of intractable pain. It has a history of more than 30 years in the United States and has been implemented in the pain departments of some top three hospitals in my country. The implantation process includes: preoperative evaluation (pain symptoms and psychological evaluation) → drug test (estimate the efficacy, decide whether to implant) → surgical implantation (minimally invasive and safe) → postoperative follow-up (return to the hospital every six months, replacement Drug in the pump). The surgical operation is minimally invasive, including subarachnoid puncture, drug delivery system implantation, and subcutaneous tunnel establishment, which can be completed in about 1 hour.
Finally, I want to remind everyone that if you take the initiative to treat pain as early as possible, you can save cancer patients from torture and ensure a good quality of life during the long time of coexisting with tumors.