Causes of cancer pain

In modern society, the treatment of advanced cancer pain is not only a medical problem, but also a social problem involving a wide range. According to the statistical data quoted by Health News on June 5438+February 30, 2003, in the analysis of the causes of death of urban population in China in 2000, cancer pain in the late stage ranked first, and rural areas ranked second. According to statistics, there are more than 7 million cancer patients in China, of which 5 1-62% are accompanied by different degrees of pain, of which 40% are mild pain and 30% are moderate pain. At present, there are about 654.38+0.60-2 million new patients and about 654.38+0.3 million deaths in China every year. For most patients with advanced cancer pain, the biggest pain is pain. According to the comprehensive analysis of 32 published articles, the World Health Organization (WHO) points out that 70% of advanced cancer can cause obvious pain, and at least 3.5 million cancer patients suffer pain every year, and only some of them may get reasonable pain treatment. According to the latest data in China, only 4 1% of patients with cancer pain in China have been effectively relieved, while only 25% of patients with advanced cancer pain have been effectively relieved. This paper introduces the common treatment methods, existing problems, analysis and countermeasures of advanced cancer pain in China at present. Up to now, scholars at home and abroad have been conducting a systematic epidemiological investigation on the pain of advanced cancer. FOLEY( 1979) reported that the incidence of cancer pain was 45%-85%, PROTENOY (1989) reported that the incidence of advanced cancer pain was 95%, and a group of cases in Shanghai Medical University in China was 30-79%, with an average of 69. In addition, according to the comprehensive analysis of 32 published materials, WHO pointed out that 70% of advanced cancers can have obvious pain, and at least 3.5 million cancer patients suffer from pain every year, and only some of them may get reasonable pain treatment. At the same time, the incidence and mortality of tumors are also increasing. According to statistics of Li Shuye (1998), the incidence of malignant tumor in Baoji, Shaanxi Province is 4 1.6%. Li Liandi (1997) of the National Cancer Prevention and Research Office reported that the mortality rate of malignant tumors in China was 83.65/65438+ 10,000 in the 1970s, and it rose to 108.26/65438+ 10,000 in the 1990s, with an increase of 29.42%, including an increase of 22.63% in cities and rural areas. According to the news from the National Cancer Conference in 2003, in recent years, the incidence of cancer in China is on the rise, and malignant tumor still ranks first among the causes of death in urban population. In 1980s, the World Health Organization (WHO) put forward the goal of "making cancer patients painless" on a global scale by 2000. Despite the efforts of the whole world, especially the efforts of our government and a large number of managers and medical workers who are interested in cancer pain treatment in recent ten years, there is still a big gap in the field of cancer pain treatment in China until now. How to further strengthen the treatment of tumor pain is not only the task of medical workers, but also one of the tasks of the whole society. This paper introduces the common methods and development trend of modern treatment of advanced cancer pain. 1. Causes of cancer pain 1. Tumors directly compress and stimulate nerves; 2. Bone metastasis of tumor; 3. Stimulation of tumor on pain-sensitive tissues (blood vessels, lymphatic vessels, etc.). ); 4. Pain caused by tumor secretion factors and accompanied by inflammatory factors; 5. Pain after surgery, radiotherapy and chemotherapy; 6. Psychological factors. Second, cancer pain grading and curative effect evaluation According to the grading and curative effect evaluation standard of cancer pain formulated by WHO in the early stage, cancer pain grading is as follows: 1, pain grading is 0 ~ 3, and * * * is divided into four grades: 0- painless, 1- mild pain, 2- moderate pain and 3- severe pain. 2. Efficacy evaluation: complete remission (CR), partial remission (PR), mild remission (MR) and no remission (NR). In order to quantitatively analyze the statistical data in clinic, we have been using visual analogue scale (VAS) for many years to evaluate the degree of pain and the degree of relief after treatment. The basic method is to use a swimming ruler with a length of about 10 cm, with a scale of 10 on one side and "0" and "10" on both ends respectively, where "0" means painless and "10" means the most severe unbearable pain, which will be marked in clinical use. The doctor graded the patient according to the position of the mark. The advantage of this method is objective and simple, because all patients have the same starting point of pain experience, and the degree of relief after treatment is easy to express. We classified "0" as painless, "1-3" as mild pain, "3-5" as moderate pain, "5-8" as severe pain and "8- 10" as extreme pain. Evaluation of curative effect after treatment: 0-2 is excellent, 3-4 is good, 5-7 is fair, and > 7 is poor. III. Drug Treatment (Three-step Therapy) The World Health Organization (WHO) organized and held an internationally renowned expert meeting on neurology, anesthesiology and oncology in Milan, Italy on 1982, and established a WHO expert committee on pain treatment to discuss and formulate the "WHO Three-step Therapy Plan for Cancer Pain". It is agreed that the pain of most cancer patients can be relieved by using the existing and limited analgesic drugs, and it is formally proposed to be realized globally by 2000. In April, the Ministry of Health of China issued the document 199 12, which informed the deployment of "three-step analgesic treatment for cancer pain patients" in China, and at the same time emphasized strengthening management and preventing abuse. The so-called "three-stage analgesic ladder therapy" method is to make a correct evaluation of the nature and causes of cancer pain, and choose the corresponding analgesic drugs according to the degree and causes of pain, that is, patients with mild pain mainly choose antipyretic and analgesic analgesics, patients with moderate pain should choose weak opioids, and patients with severe pain should choose strong opioids. 1, the main principles of three-step treatment of advanced cancer pain ① oral administration should first choose oral administration route, and avoid traumatic administration route as much as possible in clinic to facilitate patients to take it for a long time. ② Taking medicine on time should be given regularly "on time" (Q3 ~ 6h) instead of "on demand"-for example, only when there is pain. ③ According to the medication procedure stipulated in the principle of three-step treatment of advanced cancer pain, from the first step, the step-by-step medication should be used reasonably. ④ Individualized medication, paying special attention to the actual curative effect of specific patients. 2. According to the principle of three-stage analgesic ladder treatment for cancer patients, the recommended drugs mainly include analgesic drugs and auxiliary drugs: analgesic drugs ① non-steroidal anti-inflammatory analgesic drugs (NSAID): represented by aspirin and indomethacin, used for mild pain. ② Narcotic analgesics: represented by weak opioids such as tramadol and codeine, there are quick-release tablets, sustained-release tablets, injections or capsules. Clinically, it is mainly used to treat moderate pain. Strong opioid drugs, such as fentanyl and morphine, are represented by injections and patches. Clinically, it is used to treat severe pain. Adjuvant drugs ① antipsychotics and antidepressants: Diazepam, droperidol, amitriptyline and doxepin are the representatives. ② Hormones and vitamins: vitamins B, C or dexamethasone, long-acting preparation hormones, etc. ③ Special drugs: local anesthetics (lidocaine, bupivacaine, ropivacaine, etc. ) and corrosive drugs (anhydrous ethanol, phenol glycerol, etc.). ). Principles for the use of auxiliary drugs ① Treatment of special types of pain: such as moderate or severe neuropathic pain; (2) Improve the common accompanying symptoms of patients with cancer pain, such as obvious depression or anxiety treatment; ③ Increase the analgesic effect of the main drug or reduce the side effects; ④ Adjuvant drugs can't be administered routinely, which depends on the specific situation of patients. 3. Precautions ① Master the starting time of analgesic drugs. As long as patients reflect pain clinically, they should be treated; ② Pay attention to the treatment of patients at different stages and pain at different stages: according to the principle of three-step treatment, adjust the types and doses of drugs in time to maximize its clinical efficacy and minimize its side effects; ③ Rational route of administration: according to the specific situation of patients, oral route of administration is preferred; ④ Prevention and treatment of tolerance: pay attention to finding effective formula, change dosage form in time to avoid overdue use; ⑤ Update the concept of medical staff: fully understand the pain degree and psychological state of patients, use enough analgesic drugs in the early stage, and overcome the traditional concept of "restricting the use of narcotic analgesic drugs" in the treatment of advanced cancer pain; ⑥ Strengthening the monitoring of narcotic drugs: It is necessary to strengthen the monitoring of the use of narcotic analgesic drugs, and grasp the harmful side effects and clinical out-of-range application in time. Four, "three-step" therapy Three-step therapy for advanced cancer pain can effectively relieve the pain of more than 80% patients and improve their quality of life, but there are still some patients with advanced cancer pain who can't effectively relieve the pain, can't tolerate the side effects of drugs or have poor curative effect because of pain recurrence, so the application of three-step therapy is very necessary.