Causes and types of cancer pain
Some types of cancer are accompanied by physical pain. The causes of pain may vary. In some people, pain occurs as a result of tumor growth or is a consequence of the spread of the process to other organs. In other cases, the pain may occur due to complications of antitumor treatment.
You should know that doctors have modern methods and drugs to combat the pain caused by the tumor process. Therefore, in almost all cases, it is possible to cope with the pain or reduce its intensity.
There may be concern about the addiction of the patient to the drug against pain. However, practice shows that such addiction does not occur. In addition, some methods of dealing with pain do not imply the use of painkillers. These include, for example, acupuncture.
Management of cancer pain
Pain in intensity can be mild, moderate, severe and very severe. In the treatment of pain in cancer patients, non-narcotic, narcotic and auxiliary (adjuvant) drugs are used. A step-by-step approach in the treatment of pain developed by the World Health Organization.
At the first stage of treatment of low and medium intensity pain, non-narcotic drugs (neopids) are used. The main drugs in this group are aspirin, paracetamol, analgin, sedalgin, pentalgin, etc.
Aspirin is prescribed in a dose of up to 1000 mg per reception every 3-4 hours.
The dose of paracetamol and other drugs such as dipyrone is somewhat lower and is 500-600 mg per dose with an interval of 5-6 hours.
Adverse reactions of aspirin can be manifested by gastrointestinal ulcerations, bleeding disorders, and allergic reactions. Such manifestations are especially predisposed by the elderly. When using large doses of paracetamol and similar drugs, hepatotoxicity (toxic damage to the liver) may appear, which must be taken into account when prescribing these drugs in patients with impaired liver function.
Nonsteroidal anti-inflammatory drugs (Brufen, Voltaren, Indomethacin, Naprosyn) have been used successfully in the treatment of pain in cancer patients. Especially effective is the use of these drugs in combination with analgesics in the treatment of pain caused by bone metastases.
The use of non-narcotic drugs in the treatment of more severe pain is limited by their ability to anesthetize. The analgesic effect has its limits and does not increase infinitely with increasing doses of the drug. This increases only the risk of adverse reactions and manifestations of toxicity.
At the second stage of pain treatment in oncological patients, when the pain intensifies despite an increase in the dose of drugs, weak opiates (codeine, dionin, tramal) are used.
Tramal deserves special attention due to its ease of use, especially at home.
The drug is available in the form of capsules, drops, suppositories and ampoules. A single dose is 50-100 mg every 4-6 hours.
The drug is highly effective for the treatment of pain of medium and sometimes high intensity. Recently, the drug dihydrocodeine is widely used, which is available in tablets of 60, 90 and 120 mg. The effect of the drug lasts for 12 hours.
When the use of non-narcotic drugs does not give the desired effect, they switch to the use of drugs of the third stage – strong opiates (prosidol, norfin, morphine, duragesic, MST-Continus).
Prosidol is available in the form of tablets under the tongue at a dose of 20 mg, as well as in ampoules of 1 ml of 1% solution. The duration of one dose is 4-6 hours. Adverse reactions (sweating, depression) are mild and occur only in some patients.
Norfin is available in the form of 1 ml ampoules or 0.2 mg tablets under the tongue. A single dose is 0.2-0.4 mg, the frequency of administration – after 4-6 hours. The drug has pronounced adverse reactions (nausea, vomiting, constipation, depression, hallucinations)
Duragesic is a dermal drug that contains fentanyl at a dose of 25, 50. 75 and 100 g / hour and is produced in the form of a patch containing a reservoir with an anesthetic drug. The dose depends on the size of the patch. The duration of the drug is 72 hours.
The preparation of morphine MST-Continus in the form of tablets of 10, 30, 60, 100 and 200 mg of prolonged (within 12 hours) action has become widespread.
Along with the main analgesics (opiates and non-opiates), adjuvants (corticosteroids, antidepressants, anticonvulsants, antihistamines) are of great importance.
These drugs are mainly used in the treatment of individual symptoms and complications in cancer patients. They are used when prescribing drugs is limited due to low efficacy or adverse reactions.
In the presence of neuropathic (burning) pain, the use of amitriptilline antidepressant in a single dose of 25 mg and a daily dose of 50-75 mg is effective. Acute, shooting, dagger, throbbing pain responds well to treatment with analgesics in combination with the anticonvulsant drug Finlepsin in a dose of 10 mg 3-4 times a day. A combination of drugs of different stages is possible and effective, and this can reduce the dose of opiates, but the combination of several drugs of the same group does not give the desired result. and not on demand.
Adherence to this principle allows to achieve the greatest effect with a minimum daily dose of anesthetic drug. Reception on demand entails a large dose, because the drug concentration in the blood drops and this requires an additional amount of the drug to restore it and achieve the desired level of pain relief; ascending treatment means that pain treatment should be started with non-narcotic drugs, gradually moving to stronger drugs; the basis of the analgesic action; taking the drugs through the mouth should be carried out for a long period, as this is the most convenient way to use drugs for the patient, especially in homemade oviyah.