The causes of cancer pain can be divided into three categories: pain directly caused by tumors, accounting for about 88%; pain caused by cancer treatment, accounting for about 11%; pain caused by indirect tumors, accounting for about 1%. Clinically, there are also a small number of cancer patients with pain that is not associated with tumors. For example, lung cancer patients suffer from low back and leg pain caused by disc herniation at the same time. Therefore, the cause of pain in cancer patients must be clearly diagnosed.
1. Direct pain caused by the tumor
(1) Tissue destruction When a tumor invades the pleura, peritoneum or nerve, invades the periosteum or bone marrow cavity to increase the pressure or even pathological fracture, the patient may have pain, such as bone metastasis, bone pain caused by bone tumor. Lung cancer invades the pleura and can cause chest pain. The lung tip tumor invades the brachial plexus and can cause shoulder and arm pain.
(2) Compression of brain tumors can cause headaches and brain neuralgia. Neck metastases from nasopharyngeal carcinoma can compress the brachial plexus or cervical plexus, causing neck, shoulder and arm pain. Post-peritoneal tumor compression of the waist and abdominal nerve plexus can cause pain in the waist and abdomen. The nerve tissue is often oppressed by the tumor while being oppressed by the tumor.
(3) When the obstructed cavity organ is blocked by the tumor, discomfort and paralysis may occur, and severe colic may occur when completely blocked, such as stomach, intestine and pancreatic head cancer. In addition, when the axillary lymph node metastasis of breast cancer, it can compress the axillary lymph and blood vessels to cause swelling and pain in the limb of the affected limb.
(4) Tension primary and liver metastasis When the tumor grows rapidly, the liver capsule is overstretched and tightened to cause severe pain in the right upper quadrant.
(5) Tumor ulceration has not healed for a long time, and infection can cause severe pain.
2. Pain caused by tumor treatment
Pain caused by cancer treatment is a common complication of cancer treatment. Such as radiation neuritis, stomatitis, dermatitis, radiation osteonecrosis. Herpes zoster can cause pain after radiotherapy and chemotherapy. Chemotherapy drugs leak out of the blood vessels to cause tissue necrosis, chemotherapy-induced embolic phlebitis, toxic peripheral neuritis (vinblastine) in the radical mastectomy of breast cancer, which can cause swelling and pain in the arm. Incision scar, nerve injury, phantom limb pain after surgery.
3. Indirect pain caused by the tumor
Indirect pain caused by tumors, such as pressure sores in patients with exhaustion, and low immunity can cause local infections and pain. In addition, bone metastasis occurs in the prostate, lung, breast, thyroid cancer, etc., causing severe abdominal pain.
It is the result of many factors of advanced cancer pain, including physical, psychological, social and spiritual factors.
2. Unstoppable pain
After weeks or months of pain, especially with insomnia, many cancer patients are subdued by pain, and the pain envelopes their entire mental field of vision. Such patients often find it difficult to accurately depict the location or nature of the pain.
3. With strong autonomic abnormalities
In most patients, the response to persistent pain is autonomic, and the patient is mentally and physically regressive and appears to be depressed. Some patients have an anxiety predominance, or anxiety and depression are mixed together. In all cases of unstoppable pain, there is a vicious circle of “insomnia → fatigue → pain → insomnia.”
4. Accompanied by psychological abnormalities
Psychological evaluation and initial psychological support should be used in the diagnosis. When anxiety is prominent, the treatment should include analgesics and anxiolytics, and the choice and dosage of each drug depends to a large extent on what the patient has taken before.
5. With somatization symptoms
Cancer pain affects mood and confidence affects all symptoms. However, some patients express negative emotions through physical symptoms and enclose themselves in the great pain of recurrence. In fact, they have unresolved fear, unexpressed anger and Problems common to patients with emotional conflicts.
6. Social pain
Social pain means pain associated with the expected or actual separation, or loss. Cancer patients realize that they will be separated from their families because of death. Therefore, it is important to take some measures to avoid the separation of late-stage patients from their relatives and friends. Allowing patients to visit their grandchildren and children can alleviate their pain more than increasing the dose of opioids.
7. Mental pain
The pain of cancer has been constant. The prospect of this pain and death has caused great anxiety and uneasiness. In palliative care, the role of any person or treatment is generally not so exciting. However, the basic tenet has not changed, which means that cancer pain is a physical and mental feeling, and all aspects of non-body must be expressed.
Laboratory tests: blood tests, blood biochemistry, etc. can be performed. When bone metastasis, blood biochemical examination found high blood calcium. Other auxiliary examinations: CT, B-ultrasound, radionuclide, MRI, X-ray, etc. help to determine the location and nature of the tumor. Nuclide examination provides a clear diagnosis of bone metastases earlier.
Cancer pain is generally based on medication, and surgical treatment often needs to be considered in combination with the overall physical condition and survival of the patient. After identifying the cause of the patient’s pain and giving it to the treatment, the analgesic effect and the degree of pain relief must be evaluated in order to develop a future treatment plan and dosage.