Cancer pain, or late-stage cancer pain, is one of the main causes of pain for patients with advanced cancer. At this stage, patients are in considerable physical and mental pain. A considerable number of patients do not die directly from cancer, but from severe pain. About 80% of patients with advanced cancer experience severe pain, and it is estimated that at least 15 million people in the world suffer from pain every day. Cancer pain has been recognized as a painful disease.
1 Diagnosis of cancer pain
The diagnosis of cancer pain is the basis for the treatment of cancer pain. The key points of diagnosis include confirming the mechanism of cancer pain, the characteristics of cancer pain, and assessing the scope of pain. Differentiate the nature of pain with degree and confirm cancer pain syndrome.
1.1 The mechanism of cancer pain
When encountering patients with cancer pain, they should try their best to find the mechanism that causes pain and confirm whether there is tumor compression or invasion of nerves, blood vessels or intestines. Confirming the mechanism of cancer pain can provide a basis for formulating analgesic programs. After the cancer metastasizes to the vertebrae or ribs, invades the spinal nerve roots or intercostal nerves, and the cancer infiltrates into the pleura, peritoneum or periosteum, severe pain can occur. When cancer extends to hollow organs, pain is often accompanied by nausea and vomiting. Common areas of cancer pain include the chest and back, head and neck, abdomen, pelvis, bones and chest. In addition to the above reasons, surgical treatment and radiation therapy can also cause new pain areas or form new pain sources. Severe pain can occur when tumor cells invade or compress nerves. Tumor cells invade blood vessels and cause blood supply disorders, which can also cause pain. Liver cancer invades the liver capsule and can cause pain in the liver area. Intra-abdominal cancerous tumors can cause abdominal pain, and intestinal tumors can cause gastrointestinal obstruction. Nasopharyngeal cancer invades the trigeminal nerve and causes headaches and so on. The tumor itself can produce some hormone-like chemicals, tumor metabolites, and necrotic tissue decomposition products that can activate and sensitize chemoreceptors and baroreceptors, causing pain.
1.2 Characteristics of cancer pain
1.2.1 Cancer pain is all-round pain
The term "total pain" emphasizes that late-stage cancer pain is It is the result of many factors, including: physical, psychological, social and spiritual factors, so it can be said to be complex pain.
1.2.2 The pain is severe and unbearable
After weeks or months of pain, especially when accompanied by insomnia, many cancer patients are overcome by severe pain and are enveloped by pain. Throughout their mental vision, such patients often find it difficult to pinpoint the location or nature of pain.
1.2.3 Cancer pain is accompanied by strong autonomic abnormalities
In most patients, the response to persistent cancer pain is autonomic, and the patient suffers from mental and physical stress. They were all withdrawn and seemed depressed. Some patients have predominant anxiety or a mixture of anxiety and depression. In all cases of overwhelming cancer pain, there is a vicious cycle of ‘insomnia → fatigue → pain → insomnia’.
1.2.4 Cancer pain is accompanied by psychological abnormalities
Psychological evaluation and initial psychological support should be carried out during diagnosis. When anxiety is prominent, treatment should include analgesics and anxiolytics, with the choice and dose of each drug determined to a large extent by what the patient has previously taken. Overwhelming pain accompanied by significant anxiety is best viewed as an emergency that requires significant time to treat.
Among the psychological symptoms of cancer pain patients, anxiety and depression are the most common.
Anxiety is a feeling of worry or fear about an upcoming event that causes an increase in automatic alertness. Anxiety can cause increased pain perception, increase threats to physical health and prolong the pain experience, and can even lower the pain threshold to the point where patients feel pain from any pain.
Depression can change the transmission of pain signals and reduce the patient's ability to cope with pain. The reported incidence of depression in patients with chronic pain ranges from 10 to 100, with most reports ranging from 30 to 60. These differences may be related to the type of disease studied, diagnostic criteria, assessment tools, and the population of the study sample.
Psychological evaluation is often required when a patient complains of symptoms and pain levels that exceed the interpretation of physical signs and diagnostic treatments. Psychological assessment can reveal a patient's psychological response to pain, such as work problems, family stress, depression, and other psychological disorders. When doctors decide to conduct psychological assessment or intervention for patients, it is best to first consider whether it will improve the patient's symptoms and quality of life.
When making an assessment, you should first understand the patient's previous medical records, focusing on collecting physical medical history. It is necessary to carefully understand the drugs the patient has used before and their adverse reactions, the possibility of drug addiction, sleep problems and sexual function status, and also understand the patient's family background. The patient's education, work experience, and satisfaction with the job are critical in the evaluation. From this information, doctors can make an assessment of the patient's ability to cope.
Potential negative factors in coping include:
1.2.4.1 The tendency to catastrophize cancer pain.
1.2.4.2 Previous medical problems or adverse results of surgery.
1.2.4.3 The situation of the social support system, such as family, job search, marital crisis, etc.
1.2.4.4 The tendency to “blame” or “self-blame”.
1.2.4.5 Physical and/or emotional disorders.
1.2.4.6 History of substance abuse.
1.2.4.7 Mental disorders
1.2.5 Cancer pain accompanied by somatization symptoms
Emotional changes and reduced confidence in cancer pain patients have an impact on all symptoms Impact, however, that some patients express negative emotions through physical symptoms and close themselves in the great pain of relapse is, in fact, a problem common to all patients with unresolved fears, unexpressed anger, and emotional conflicts . Functional abdominal pain (irritable bowel syndrome) may be a lifelong way for patients to express negative emotions.
1.2.6 Pain and cancer pain coexist
Pain and suffering are not completely equivalent, therefore, pain must be distinguished from pain and other symptoms that may be associated with it. Patients can tolerate severe pain without regard to the pain they will suffer if they know that the pain has a definite cause and that the pain can be dealt with. The pain will be relatively short-lived. Even mild symptoms can cause distress, they have life-threatening causes, they are refractory to treatment, and they reflect a hopeless prognosis.
1.2.7 Social pain
Social pain means pain associated with anticipated or actual separation, or loss. Cancer pain patients realize that they will be separated from their families by death. It is important to take steps to avoid anything that could separate terminally ill patients from their relatives and friends. Allowing the patient's grandchildren and children to visit may provide better pain relief than increasing the dose of opioids.
1.3 Cancer pain intensity, distribution, and nature
1.3.1 Cancer pain intensity: Evaluating the pain intensity of cancer patients is crucial to determining treatment options. The choice of analgesic medication, route of administration, and dosage all need to be chosen accordingly. In addition, the intensity of pain can help determine the mechanism of pain; for example, pain caused by radiation nerve damage is generally not severe. Therefore, if severe pain occurs in the original radiation treatment area, it often indicates that there is a new tumor lurking. The intensity of cancer pain is generally divided into three levels: mild, moderate and severe, and can also be assessed using the visual analog scale (VAS) method.
1.3.2 Distribution of cancer pain
The distribution of pain areas can provide clues for diagnosis and treatment. The distinction between localized, multiple, and generalized pain is important in selecting treatment methods, including nerve blocks, radiation therapy, or surgery. Localized pain refers to pain that occurs only in a certain location, usually in the basic lesion area. Referred pain is defined as pain far away from the diseased area. This type of pain has the characteristics of somatic and visceral nociception and neuropathy, and can be used as a reference for evaluating organic causes.
Somatic and visceral nociceptive stimulation is similar to this and is often related to referred pain with certain characteristics. For example, neck and arm pain may be caused by heart disease, shoulder pain may be due to stimulation of the diaphragm, and knee joint pain It may be caused by hip pathology. Sufficient attention should be paid to this pattern of referred pain to improve the diagnosis of the cause of pain.
1.3.3 The nature of cancer pain
The nature of cancer pain can be used as a reference when diagnosing the tumor site. Somatic nociceptive pain can be accurately localized, and the main complaint is sharp, persistent, throbbing or compressing pain, which is a phenomenon in which somatic nerves are involved. Visceral nociceptive pain is generally diffuse, spasmodic or biting-like when hollow organs are obstructed, and becomes sharp, persistent, or throbbing when it invades the organ capsule or mesentery. Neuropathic pain caused by involvement of the peripheral nerve main trunk or its branches is burning, pinprick-like, radiating in a certain direction, or pain similar to an electric shock.
1.4 Classification of cancer pain
Cancer-related pain can be divided into acute and chronic. Acute pain is characterized by a recent onset, a brief history, a clear time of occurrence, and a confirmed cause. Chronic pain refers to other chronic pain diseases in which pain lasts for 1 month or longer, exceeds the general course of acute illness or injury, or is combined with chronic lesions and recurs intermittently within months or years.
1.4.1 Acute cancer pain
Acute cancer pain can occur due to sudden changes in the condition or due to diagnostic and treatment measures.
1.4.1.1 Acute pain caused by chemotherapy;
1.4.1.2 Acute pain caused by radiotherapy;
1.4.1.3 Acute pain caused by immunotherapy ;
1.4.1.4 Acute pain caused by infection;
1.4.1.5 Headache after lumbar puncture;
1.4.1.6 Pain during epidural injection;
1.4.1.7 Acute pain caused by hormone therapy;
1.4.1.8 Painful cramps caused by drugs.
1.4.2 Myofascial pain
Myofascial pain is the most common bony muscle disease in the neck, shoulder girdle and waist. Debilitated cancer patients are several times more likely to develop myofascial pain than the general population.
1.4.3 Cancerous visceral pain
When we talk about cancerous visceral pain, we should pay attention to the following issues:
Visceral pain is not entirely caused by internal organs. Visceral pain is not related to internal injury. Visceral pain often involves other parts. The pain is diffuse and difficult to locate. Visceral pain can be an accompanying symptom of strong movement and autonomic nerve reflexes. All forms of visceral pain are poorly localized, with most experiencing pain over an area significantly larger than the original visceral area. Moreover, when the pain is more intense, the area of ??the body where the pain is felt is larger. This suggests that the representation of visceral organs in the central nervous system is not very precise.
1.4.4 Neuropathic pain;
1.4.5 Nerve compression pain;
1.4.6 Sympathetic persistent pain;
1.4.7 Bone metastasis pain;
1.4.8 Pain caused by opioids;
Opioid headache: A very few patients develop full-body headaches after taking opioids, and they repeat Can still occur during dosing and may be related to opiate-induced histamine release.
Intraspinal opioid hyperalgesia syndrome: Occasionally abnormal reactions after intrathecal or epidural injection of large doses of opiates, characterized by pain, hyperalgesia, myoclonus, piloerection and priapism. The pain is mainly in the perineum, buttocks and thighs. This is a rare phenomenon, and the above symptoms resolve quickly after stopping the drug.
Paralgesia and myoclonus have been found in humans after high-dose intrathecal (1T) morphine injection or high-dose intravenous (1V) morphine.
2 Treatment of cancer pain
Drug therapy is the main means to relieve cancer pain. Correct selection of drugs, appropriate route of administration, individualized correct dosage, and regular intervals. Etc. is an important principle in the drug treatment of cancer pain. According to this principle, the analgesic rate should be very high.
The active cancer pain treatment principles currently advocated include:
1. Pay attention to and understand the importance of comprehensive pain treatment.
2. Choose a treatment method with good compliance.
3. Both doctors and patients are willing to take responsibility.
4. Patients actively participate in treatment, are interested in jointly improving treatment plans, and have realistic expectations for treatment results.
2.1 Principles of treatment of cancer pain
For the application of analgesic drugs to treat cancer pain, the World Health Organization has proposed the following principles:
1. The principle of individualization: The dosage of analgesics should be individualized.
2． It is best to take the medicine orally: Oral medicine does not require help from others and is more convenient. Regular oral morphine has become the mainstay of treatment for chronic cancer pain.
3. Treat insomnia aggressively: Pain often worsens at night, interfering with the patient's sleep. This condition can cause the patient's body to fail. Applying a larger dose of antacid at night can prolong the analgesia and make the patient sleep peacefully.
4． Side effects must be dealt with systematically: Common side effects of strong opioids include constipation; nausea and vomiting, and antiemetics and laxatives should be given. Almost all patients taking morphine require laxatives, and most require antiemetics. Long-term users of strong opioids rarely develop respiratory depression that requires treatment.
5. Carefully observe the effect: When patients receive analgesic treatment, no matter what kind of analgesic they are, they need to be carefully observed to achieve the best effect and the least side effects.
6. Understand the nature of cancer pain: As the saying goes, "prescribe the right medicine to the case", and the treatment of cancer pain is no exception.
2.2 Three-step plan to control cancer pain
The treatment of cancer pain must be based on accurate diagnosis. After correctly evaluating the cause and nature of the pain, the first choice is the three-step drug plan for pain relief.
2.2.1 Preferred drug - non-opioid drugs (first step)
Nonsteroidal anti-inflammatory drugs: such as aspirin, paracetamol, ibuprofen, diclofenac sodium, etc. Mainly targeted at mild and moderate peripheral cancer pain. It can often relieve the pain of bone metastasis cancer. This is because cancer cells in bone metastases produce a lot of prostaglandins, and non-steroidal anti-inflammatory drugs can block the synthesis of prostaglandins and also have antipyretic and anti-inflammatory effects. This type of medicine is also effective for pain caused by mechanical traction of the periosteum by tumors, pressure on soft tissues such as the waist, muscles or subcutaneous tissue, or pressure on the thoracoperitoneum.
2.2.1.1 Acetaminophen
It is mainly used to treat neck cancer headaches, neuralgia and post-operative pain. Each tablet is 0.5g, take 0.5~1.0g orally each time, 3~4 times/d. Note that taking too much of this medicine can cause tinnitus and deafness. Liver and kidney dysfunction. Disabled for those allergic to aspirin.
2.2.1.2 Compound aspirin tablets
Each tablet contains aspirin 0.2268g, phenacetin 0.162g, and caffeine 0.035g. Take 1 to 2 tablets orally each time, 3 times/d. Pay attention to the damage to kidney function during long-term use.
2.2.1.3 Feprazone
Adults take 100 to 200 mg orally, twice a day. Use with caution in patients with poor liver and kidney function.
2.2.1.4 Diclofenac
Orally administered 25 mg each time, 3 times/d; suppository 50 mg each time, rectally taken, 2 times/d; injection preparations can also be used, 75 mg each time , 4 times/d, deep intramuscular injection. Use with caution in patients with liver and kidney dysfunction and a history of ulcers.
2.2.1.5 Ibuprofen
Adults take 0.2g orally once. If the pain or fever symptoms persist, the medication can be repeated once every 4-6 hours, no more than 24 hours. 0.8g.
5.2.1..6 Nabumetone
Adults take 1.0g (2 tablets) orally once a day.
2.2.1.7 Piroxicam
It can be applied once a day, 20 mg each time after meals.
The total daily dose does not exceed 40mg.
2.2.2 Weak opioid analgesics - the second step
Moderate neck cancer pain is often persistent pain, and the patient’s sleep Has been disturbed, appetite has decreased. Patients with this type of pain need to use weak opioids, but in principle, the medication should adopt the principle of gradual transition to the second step, that is, while giving non-steroidal anti-inflammatory drugs, analgesics, such as tramadol or Weak-potency opioids, such as codeine, dextropropoxyphene, etc. Neuroleptics and hypnotics can be taken at night. Indicated when non-opioid medications do not provide satisfactory pain relief.
2.2.2.1 Tramadol
Usually taken orally or intramuscularly, oral tramadol (50mg each time, once/6h) and single application of tramadol 100mg The stable plasma concentrations achieved were the same, supporting the use of lower-dose therapy in patients with chronic pain. Therapeutic doses of tramadol have no respiratory depressant effects.
Tramadol suppositories were used for patients with neck bone tumor pain, 50 to 100 mg/time, 3 times/d. 64 patients had obvious and complete pain relief, and the total effective rate was 80%. Someone injected tramadol 50 mg intramuscularly into 53 patients with cancer pain, and 66% of the patients were satisfied with the analgesic effect; after intravenous injection of 50mg, 73.3% were satisfied with the analgesic effect.
2.2.2.2 Codeine
The analgesic effect of codeine is only 1/6 of morphine. This may be because the drug needs to be demethylated in the liver to become morphine. To be able to function. Take 30mg orally each time, 3-5 times a day.
2.2.2.3 Pentazocine
Pentazocine (pentazocine) is a phenylmorphine synthetic drug. The methyl group at the N position of the piperidine ring is isopentyl. Partial opioid receptor agonists substituted by alkenyl groups have both opioid receptor agonism and weak opioid receptor antagonistic effects.
The analgesic efficacy of pentazocine is about 1/3 of morphine, that is, 30 to 40 mg of this drug is equivalent to 10 mg of morphine. It is reported that pentazocine is used in the treatment of cancer pain, and the analgesic effect of 6.0 mg is equivalent to that of 10 mg of morphine. Pentazocine takes effect approximately 20 minutes after intramuscular injection and lasts approximately 3 hours.
2.2.3 Strong opioid analgesics - the third step
Strong opioid analgesics, represented by morphine, are the main method for the treatment of moderate and severe cancer pain. It is the third step treatment drug selected when there is a difference in pain relief between weak opioid analgesics and non-opioid analgesics (or combined auxiliary drugs). Most patients are satisfied with the pain relief using this drug.
The application of strong opioid analgesics should take into account many factors, such as age, gender, general condition, type of cancer, and severity and extent of pain. Dosage varies greatly among individuals, and it is usually recommended to start with a small dose and increase to an appropriate dose based on clinical experience.
2.2.3.1 Morphine
The more commonly used oral drug in the third step of treatment is MexiContin (ie, morphine controlled-release tablets). Each tablet contains 30 mg of morphine, and each time it is 1~ 2 tablets, taken orally every 12 hours. If oral administration is not possible, it can be administered through the anus. Other powerful opioids include morphine, dihydroetorphine hydrochloride, methadone, pethidine, fentanyl, buprenorphine, levorphanol, etc.
The reasons why WHO recommends morphine as a representative powerful opioid for the treatment of cancer pain are: ① Morphine is available in most countries and regions in the world and is cheap. ② In-depth research: Its pharmacological characteristics can be understood from many aspects, such as pharmacokinetics, adverse reactions, etc. There is already an effective morphine antidote - the opioid receptor antagonist naloxone. ③The time of action is equal to the half-life. ④The dose can be increased at any time; ⑤Administration via multiple routes: oral administration, long-lasting analgesic effect, few complications, and the dose can be increased when it is ineffective; when oral administration is not possible, transrectal, intravenous drip, intramuscular or subcutaneous injection can be used , epidural space or subarachnoid space administration, etc.
2.2.3.2 Fentanyl
Fentanyl is a potent μ-opioid receptor agonist with high affinity and intrinsic activity for μ-opioid receptors. May cause central nervous system analgesia and sedation. It takes effect immediately after intravenous injection and lasts approximately 30 minutes.
It takes effect approximately 15 minutes after intramuscular injection and lasts for 60 to 120 minutes. Suitable for intraspinal and transdermal continuous micro-administration.
2.2.3.3 Methadone
The pharmacological effects of methadone are similar to those of morphine, but the utilization rate of oral morphine is low, while oral administration of methadone is equally effective as injection. Its analgesic intensity and duration are comparable to those of morphine. Tolerance and addiction develop slowly, withdrawal symptoms are mild, and they are easy to treat.
2.2.3.4 Buprenorphine
Buprenorphine is a derivative of thebaine, a long-acting and powerful analgesic, and a mixed opioid receptor agonist- antagonist drugs. Its analgesic potency is about 50 to 100 times that of morphine and 100 to 150 times that of pentazocine. The maximum limit is 3 to 5 mg/d. It is an effective analgesic for moderate or above pain. Most patients can achieve satisfactory pain control by taking the drug every 8 hours. Take it sublingually at 0.4 mg each time, or inject it. Intramuscular injection of 0.3 mg each time. The analgesic effect of sublingual buprenorphine is 60 times that of oral morphine (buprenorphine 0.2 mg sublingually, q8h is equivalent to morphine 6 mg orally, q4h). If buprenorphine is ineffective for the patient's pain and it is necessary to switch to oral morphine, the initial daily dose of morphine should be 100 times the daily dose of buprenorphine, once every 4 hours.
2.3 Radiotherapy for cancer pain
For some cancer pain, special treatments including radiotherapy must be considered. Can be used alone or in combination.
Cancer pain caused by bone infiltration is more common, and radiotherapy is more effective in treating pain caused by histological metastases. The pain relief rate for bone metastases of the most common breast cancer, lung cancer, prostate cancer, thyroid cancer and myeloma can reach more than 80%. All pathological fractures caused by bone metastasis cancer will cause pain. If conditions permit, surgery and internal fixation should be performed, followed by local radiotherapy after surgery. Radiotherapy is the main radical treatment method for head and neck cancer. Even in very advanced stages, high-dose radiotherapy can be used, because if the growth of the tumor is not controlled, the development of cancer will be more painful than the response to high-dose radiotherapy.
2.4 Nerve damage therapy for cancer pain
Most patients with cancer pain have improved their pain relief rate through the three-step treatment principle; however, clinically, there are still patients with cancer pain who have ineffective pain relief. Satisfied, and had to consider other ways to control cancer pain. Nerve-damaging block is an effective nerve-damaging treatment for refractory cancer pain. Some patients with cancer pain still have severe pain after strict application of the "three-step drug treatment plan", or they are unable to fully receive the treatment of the "three-step plan" because they are unable to eat, have drug contraindications, or cannot tolerate analgesics. , called intractable cancer pain or refractory cancer pain, is an indication for nerve-damaging block.
Nerve-damaging blockade provides an excellent way to control chronic cancer pain. The success of these nerve blocks relies on patient understanding and cooperation as well as the physician's experience and skills. With appropriate training and operation, treatment under the guidance of imaging equipment significantly improves safety.
2.4.1 Peripheral nerve destructive block
When cancer pain is relatively localized and drug treatment is ineffective, different concentrations of phenol, ethanol, doxorubicin and mitogen are used. Satisfactory results can often be achieved by blocking peripheral nerves with mycin solution or using radiofrequency to damage the nerves. Although peripheral neurolysis has limitations in the treatment of pain caused by malignant causes, its role is clear. To ensure effective analgesia, the nerve block must be located proximal to the irritant. This can be done in an outpatient setting or at the patient's home. It should be used for those whose pain is more localized or who have residual local pain after using other methods of block. Commonly used nerve blocks include the maxillary nerve, mandibular nerve, auriculotemporal nerve, greater occipital nerve, suprascapular nerve, femoral nerve, obturator nerve, sciatic nerve, and peroneal nerve.
2.4.2 Subarachnoid nerve destructive block
The analgesic effect and duration of subarachnoid phenol or ethanol block are superior to local nerve block and Nerve root block. This method is effective in controlling cancer pain, but requires an experienced anesthesiologist. Phenolglycerol block is currently more commonly used. Those with excellent analgesic effects accounted for 50% to 60%, those with good analgesia accounted for 21% to 30%, and those with poor analgesia accounted for 18% to 20%.
The quality of the effect is closely related to the tumor location, puncture gap, injection dose and pain evaluation method. Most reported pain relief lasts from 2 weeks to 3 months, with a few patients lasting 4 to 12 months. Among the patients who have been followed up by the author, 58% have good analgesic effects (no pain before death), 26% have good analgesic effects (residual pain, only taking non-steroidal analgesics to achieve painlessness), and the rest have relatively good analgesic effects. Poor or relapse in a short period of time. The analgesic duration of a single block ranged from 21 to 270 days, with an average of 94.3 days. Complications after blockade are mainly caused by damage to non-pain-sensing nerves. All treatments should be performed in the operating room. Complications of bilateral blocks include urinary retention, rectal dysfunction, and muscle paralysis, which usually resolve or disappear within a week.
2.4.3 Epidural space nerve-damaging block
Epidural space block injects nerve-damaging drugs into the epidural space to block spinal nerve conduction and produce spinal cord block. Segmental analgesia. Compared with peripheral nerve block, epidural block can block the somatic and autonomic nerves at the same time, with a larger block range and precise effect; compared with subarachnoid block, it can avoid meningeal stimulation and spinal cord or spinal cord blockage. Spinal nerve injury, and because nerve-damaging drugs do not directly contact nerve roots and act outside the dura mater, the bladder and rectal sphincter are less likely to be affected than subarachnoid block, but its effect is not as good as subarachnoid block. block. In addition, nerve-damaging drugs can be injected in stages through the epidural catheter.
2.4.4 Celiac plexus ethanol block
Celiac plexus ethanol block treats pain caused by abdominal tumors, especially pancreatic cancer pain. About 60-85% of patients can Get pain free. It needs to be done under X-ray fluoroscopy.
Celiac plexus block can effectively relieve upper abdominal pain and referred back pain caused by foregut-derived malignant tumors. It is most commonly used for pancreatic cancer, which, contrary to conventional wisdom, is most commonly characterized by pain rather than painless jaundice. NCPB is also effective for tumor-induced pain in the distal esophagus, stomach, liver, bile duct, small intestine, proximal colon, adrenal glands, and kidneys.
Celiac plexus block should be considered for pain caused by intra-abdominal malignant tumors that are not effectively treated by other methods. A review of the literature revealed that pancreatic cancer pain is the area where this block is used most and with the best results. However, for pain unrelated to the afferent fibers of splanchnic nerves, such as pain caused by lesions in the esophagus, chest wall, abdominal wall, peritoneum, mesenteric root, cervix of the uterus, bladder, etc., this block is ineffective or ineffective. Celiac plexus blocks have been reported to be effective for colon and rectal cancer pain.
In short, cancer pain patients often endure physical and mental pain. They are often troubled by inappropriate treatment methods and hope for a miracle to happen. Neurodestructive blocks offer an excellent way to control chronic cancer pain. The success of these nerve blocks depends on the patient's understanding and cooperation and the physician's experience and skill, with appropriate training and performance.