“I’m not afraid of getting sick, but I’m afraid of suffering!” Is it true that patients with advanced refractory cancer pain at home can only endure alone at home? Can’t you control the pain? Of course not!
I. Overview
of Cancer Pain
Cancer pain refers to the pain caused by cancer itself or cancer treatment, and its causes are complex. On the one hand, the tumor itself will cause compression, invasion and destruction to the surrounding tissues and organs in the process of growth, causing pain; at the same time, the infiltration and growth of the tumor can induce the increase of prostaglandin synthetase activity, produce a large number of prostaglandins leading to pain, and may also cause neuropathic pain due to the compression of nerves by growth, as well as obstruction caused by the tumor.
Cancer pain has a huge impact on patients. First of all, it will affect the patient’s mood and make the patient anxious and depressed. Secondly, it will affect appetite, leading to poor appetite of patients, and then affect the nutritional intake of patients. Moreover, it can affect the quality of sleep and even lead to insomnia. Long-term cancer pain will make the patient’s mental state poor and the body’s immunity decline, which will not only affect the therapeutic effect of tumors, but also accelerate the growth of tumors. Some patients choose to commit suicide because their long-term pain can not be effectively controlled.
It can be seen that cancer pain is not only a symptom, but also a disease that seriously affects the quality of life and life safety of patients with the development of the disease or the extension of its existence time. Therefore, home analgesia is very important for patients with cancer pain, which can relieve pain and improve the quality of life in a familiar environment.
2. Drug therapy
for home analgesia
(1) Medication for
mild cancer pain Patients with
mild cancer pain can take non-steroidal anti-inflammatory drugs, which mainly include ibuprofen and acetaminophen. Generally speaking, in the hospital clinic, mild cancer pain patients taking these drugs can play a better pain relief effect. For example, ibuprofen extended-release capsules are excellent at relieving mild cancer pain by inhibiting the synthesis of prostaglandins in the body, thus exerting analgesic, anti-inflammatory and antipyretic effects. Acetaminophen is also one of the commonly used drugs, which has a similar mechanism of action and can effectively alleviate mild cancer pain. However, it should be noted that when patients use these drugs, they should strictly follow the doctor’s advice and avoid adjusting the dosage by themselves. At the same time, we should pay attention to observe whether there are adverse reactions, such as gastrointestinal discomfort, dizziness and so on. If the pain develops severely, they should seek medical treatment in time and adjust the medication plan.
(2) Medication for
moderate cancer pain
For patients with moderate cancer pain, weak opioids, such as tramadol sustained-release tablets, can be taken. Tramadol is a synthetic central analgesic with a complex mechanism of action, which can not only act on opioid receptors, but also inhibit the reuptake of norepinephrine and 5-hydroxytryptamine, thus playing an analgesic role. When patients have moderate cancer pain, tramadol sustained-release tablets can effectively relieve pain and improve the quality of life of patients. In addition, codeine, ibuprofen, codeine, oxycodone and other drugs can also be used for the treatment of moderate cancer pain. These drugs can be used alone or in combination with non-opioid drugs to enhance analgesia. However, it should also be noted that patients should use drugs under the guidance of doctors and avoid increasing or decreasing the dosage on their own.
(3) Drugs for
severe cancer pain Patients with
severe cancer pain need to follow medical supervision to use opioid analgesics, including oxycodone, fentanyl, morphine and so on. Among them, morphine sulfate sustained-release tablets and oxycodone hydrochloride sustained-release tablets are commonly used oral drugs, and fentanyl transdermal patch is also an effective way of administration. These drugs have powerful analgesic effects, but the following points should be noted when using them: First of all, oral administration is the first choice for drugs, which can ensure the stable absorption and sustained effect of drugs. Secondly, if oral opioids are used continuously for more than one week, they can produce dependence, and for non-cancer pain relief, they should be used for a short time. Opioids can reduce the sensitivity of respiratory center to carbon dioxide, such as excessive use can produce respiratory depression, which is contraindicated in patients with severe chronic obstructive pulmonary disease, respiratory depression, pulmonary heart disease, craniocerebral injury, etc. It is also forbidden for lactating women, patients with severe hepatic and renal insufficiency, dysuria and intestinal paralysis. In addition, opioids can cause adverse reactions when combined with metformin, cyclophosphamide, atropine, levodopa, rifampicin and other drugs, and should be avoided. While using opioids, it can also be used with some non-steroidal anti-inflammatory drugs, which can effectively enhance the analgesic effect of opioids and reduce the dosage of opioids. However, patients must use drugs under the guidance of doctors, and never adjust the dosage or medication plan by themselves.
3. Non-drug therapy
for home analgesia
(I) Comfortable body position
When the
patient is in the recumbent or semi-recumbent position, it can effectively relieve the tension of the abdominal wall, thus relieving the pain. For example, patients with cancer pain after surgery can not only relieve the pain of surgical trauma to a certain extent, but also benefit the respiratory and circulatory functions by using different bed positions. On the basis of ensuring the safety of patients, try to make patients comfortable. The recumbent position can be changed as required, for example, the supine position is changed into a low-slope semi-reclining position, the head of the bed is raised by 15-30 degrees, and a small pillow is placed under the knee, so that the tension of the abdominal wall muscle anastomosis of the patient can be reduced, the abdominal pain can be relieved, and the small pillow is placed under the knee to prevent the body from sliding down and increase the comfort. The high slope semi-reclining position is to raise the head of the bed by 30-40 degrees and put a small pillow under the knee, but attention should be paid to prevent the patient from falling into bed. Patients with low or unstable blood pressure should not be given a semi-reclining position, but a supine position.
(2) Diversion of attention
Diversion is an effective non-pharmacological method of analgesia. Patients can reduce pain by reading novels, comics, TV programs, books and other ways to distract their attention. Studies have shown that when patients focus on what they are interested in, the brain secretes neurotransmitters such as endorphins, which have analgesic effects. For example, patients can watch some humorous novels or cross talk, clap their hands with the rhythm while enjoying them, or watch some fast-tone music videos, so that they can immerse themselves in a happy atmosphere and temporarily forget the pain.
(3) Take a deep
breath
When patients feel pain, try to give priority to chest breathing, which can reduce the pressure stimulation of the abdomen. Deep breathing can relax the body, regulate the rhythm of breathing, and reduce the tension and anxiety caused by pain. The patient inhales slowly to expand the chest, then exhales slowly to feel the contraction of the abdomen. Repeat this process, keeping each breath as even, slow, and deep as possible.
(4) Reasonable diet
Reasonable diet is very important for cancer pain patients. Patients should choose light, high-protein, low-fat, non-stimulating and digestible food. Such a diet can reduce the burden on the intestines and stomach, avoid discomfort such as abdominal distension caused by indigestion, and thus reduce the inducing factors of pain. For example, patients can eat more foods rich in vitamins, proteins, inorganic salts and dietary fibers, such as lean meat, beef and mutton, soybean products, etc. At the same time, we should pay attention to eating less and more meals, not too full, and keep the stool smooth. Because patients lie in bed for a long time, intestinal peristalsis is relatively slow, which restricts food intake, so they need to choose some crude fiber foods, such as honey, which can promote gastrointestinal peristalsis.
(5) Emotional stability
Maintaining emotional stability can reduce pain. Anxiety can easily increase pain, and excessive mental stress can also aggravate pain. Therefore, patients with cancer pain should improve their emotional state and apply non-drug analgesic methods. For example, massage relaxation therapy, patients can massage gently locally, but pay attention to the strength, not force, so as not to cause mass rupture or spread. They can also listen to music, plant flowers and plants, watch TV, practice Qigong and so on, which can divert their attention.
Family members of
patients should also actively cooperate and communicate with patients to avoid too much tension and fear, so that patients can maintain a positive and optimistic attitude and cooperate with doctors for treatment.
Cancer pain
