16.05.2019
Strong painkillers for cancer. How is anesthesia for oncology performed? Modern principles of pain syndrome treatment in oncological diseases
Pain causes physical, psychological and moral suffering to the patient. Pain in oncology can be controlled with non-narcotic analgesics and adjuvant agents, a combination of opioids with non-narcotic analgesics. At the fourth stage, such therapy does not bring the desired effect. It is necessary to relieve pain with the help of potent drugs: opioids from the morphine group with the addition of a drug from the group of non-narcotic analgesics and adjuvant drugs.
Massage can help provide temporary relief from certain types of cancer pain, such as bone pain. Massagers may require written permission from your oncologist, as massage may stimulate circulation. Do not rub on areas where you have recently received radiation therapy, as this may irritate the skin. cold temperature can help dull pain and reduce inflammation. This is especially helpful for surgical pain, such as pain at the site of an incision. Some patients use a bag of frozen corn or peas as this can be molded into the shape of the body more easily than an ice bag. Heat can help with some types of pain by relaxing muscles and stimulating circulation. For example, soaking the hands and feet can sometimes provide temporary relief from Raynaud's phenomenon and peripheral neuropathy. Wet air can also help with chest pain. Washable thermal wraps. Laying a damp, hot towel over the source of the pain may also help. Some manufacturers produce heat packs containing hygroscopic granules that are heated to the correct temperature in a microwave oven. These balls absorb moisture from the air and release it when heated, resulting in moist warmth that can be therapeutic in nature. back pain. This stimulates the nerves and can temporarily block certain forms of localized pain. This is often used by physical therapists along with a wet towel. anyone with a heart condition or suffering from seizures. Acupuncture and acupressure. Gentle exercise can help with some forms of pain. Lying or sitting for long periods of time can cause pain and bedsores, so it is recommended to change position from time to time. Special molded pillows can be helpful, as well as mattresses that relieve pressure. Beaded nylon "hugging" pillows, available from many department stores, can also help. If you suffer from back pain, try using a wedge pillow to change the angle of your head relative to your body. Also put a pillow under your knees. Try also placing a rolled up towel in the lumbar position of your back. A physical therapist can teach you exercises to relieve some types of mild pain. By directing your attention away from the pain, you can help provide temporary relief. If you have nothing to do but focus on the pain, the pain will get worse. If you can read a book, watch TV, listen to music, or talk with friends, it can take your mind off the pain for a while. Boredom and depression reduce pain tolerance.
- This may be enough to put a cancer patient to sleep.
- Percussion and vibration masseurs can also help.
For each cancer patient, doses are selected according to individually. Reception of prescribed analgesics must be carried out strictly at the same time. It is preferable to use the oral, sublingual or buccal form of drugs, suppositories, patches.
At the first stage, non-steroidal anti-inflammatory drugs are prescribed to relieve pain, the addition of a small amount of narcotic analgesics allows you to stop moderate pain.
Hypnosis, meditation, visualization, aromatherapy, breathing techniques, and relaxation techniques are rarely enough to fight cancer pain. But they can help reduce stress and emotional anxiety and increase the effectiveness of other cancer-fighting treatments. Talking to a consultant can also help. Some religious people have found that praying and talking with a religious chaplain can help reduce anxiety.
Getting enough sleep can help you manage your pain. Cancer patients who don't get enough sleep often have a harder time coping with pain. Pain can also make it harder to fall asleep and increase fatigue. If you have trouble sleeping, talk to your doctor. Some of your medications, such as steroids, may cause insomnia. Your doctor may change your medication schedule so that you take steroids in the morning instead of in the evening. He may also prescribe mild sedatives or sleeping pills to help you fall asleep at night. You can also try drinking a warm milk drink.
Weak opiates such as: "Tramadol", "Codeine" are recommended at a dose of up to 50 to 400 mg per day to relieve increasing pain. A combination of weak opioids with non-narcotic analgesics is possible. The most commonly used combinations are Codeine plus aspirin, Hydrocodone plus aspirin.
For intolerable pain, "Morphine", "Buprenorphine", "Fentanyl", "Prophydrochloride" is recommended. All drugs act on the central nervous system and cause serious drug addiction. Therefore, they are prescribed on special prescriptions with a red stripe.
Avoid exercising before bed and activities that stimulate the mind. In terminal cancer patients, palliative chemotherapy, hormonal therapy, and radiation therapy have been used effectively to reduce cancer pain, especially in bone metastases from breast and prostate cancer. Steroids and radiation therapy have been found to help with headaches caused by brain metastases.
Starting Pain Therapy
Problems with pain medications. Drowsiness and nausea usually go away after about 5 days. Many opioid pain medications can make you drowsy and interfere with your concentration. You may be disoriented and confused, or your thinking and memory may not be as sharp as usual. Your reaction time will be reduced and you may be less alert. You should avoid driving or operating machinery while taking these pain medications.
At the fourth stage of cancer, Morphine relieves pain for 12 hours. It is prescribed in a dose of 30 to 60 mg. Each ampoule is accountable. After the injection is given, the doctor visiting the patient must pick up the ampoule and report on the drug used.
If the pain does not go away with the use of narcotic painkillers. Additionally, "Fentanyl" is prescribed in the form of a patch.
All opioid pains can cause constipation. Your doctor may prescribe a laxative to help with this problem. Two laxatives are often prescribed, one as a stool softener and the other to stimulate the bowel. Consuming dietary fiber and drinking water can help.
Another common problem with opioid pain medications is dry mouth. Drinking water can help solve this problem. Opioid pain relievers can also cause headaches. Allergic reactions to opioid pain medication are rare. If you have an allergic reaction after taking pain medication, call 112 or go to the nearest emergency room.
Side effects of opioids
Most often, complications are caused by an incorrectly selected dose of the drug. With insufficient introduction of "Morphine" pain is not stopped. With excess, nausea, vomiting, constipation, excessive dry mouth, respiratory failure, confusion, excessive decrease blood pressure. Any undesirable effects should be reported to the doctor immediately. It is especially worth noting that the development of drug addiction is not a reason to deprive a cancer patient of the possibility of pain relief. When changing treatment regimens, it must be taken into account that a withdrawal syndrome may develop. Therefore, the dose reduction of each drug should be carried out gradually.
Steroids can increase appetite, leading to weight gain. They can also increase blood sugar levels, leading to diabetes. Other common problems include indigestion and an increased risk of infection. If you are frequently thirsty or urinate frequently while taking steroids, tell your doctor. Steroids can also cause restlessness and irritability, making it difficult to sleep. For this reason, steroids are often given with a mild sedative such as Ativan or Valium. These sedatives can also help relieve muscle spasms.
This is a malignant neoplasm originating from the epithelial tissue of the bronchi. There are other names for the disease - bronchogenic carcinoma, bronchogenic cancer. On initial stage the disease proceeds without manifestation of any specific symptoms. The first sign is considered to be a dry cough, which gradually increases, sputum from the mucosa turns into purulent, over time, blood clots appear during expectoration. Shortness of breath, first appearing on physical activity, gradually disturbs when performing normal activities. Damage to the vocal cords is accompanied by hoarseness, the esophagus - a violation of the function of swallowing. In addition, the patient experiences pain when metastases spread to the bones, and metastasis to the brain causes visual impairment, headache, and loss of sensation in some parts of the body.
Steroids can increase fluid retention, leading to swelling in the ankles and fingers, increased blood pressure, and a feeling of bloat. Do not take antacids while on steroids without talking to your doctor, as some antacids may dissolve the coating on steroid tablets. Do not take more than the indicated dose without talking to your doctor. Too high a dose can cause serious problems such as liver or kidney failure and stomach bleeding.
When an opioid-based drug is combined with a non-opioid drug, the presence of the non-opioid may limit the number of tablets you can take per day. Do not take painkillers with alcohol. Too much pain medication can affect your breathing and lower your blood pressure, leading to dizziness or fainting. Tell your doctor right away if you experience any of these problems, as they can be very serious.
With the progression of the disease, the tumor spreads into the tissues, resulting in a pronounced pain syndrome. Some experts believe that this syndrome is observed in 80% of cases of the disease. Pain in lung cancer is most often observed in the later stages of the disease.
Causes of pain
In most cases, pain is caused by tumor pressure on organs or nerves, as well as when malignant cells metastasize to other organs or bones. In addition, some treatments (chemotherapy, radiation, surgery) can also cause pain.
If you are receiving pain medication through a skin patch, tell your doctor if you have heat. An increase in body temperature may increase the rate of absorption, resulting in too high a dose. Do not take over-the-counter pain relievers in addition to your prescription pain reliever without consulting your doctor. Many prescription pain medications contain combinations of opioid pain medications with an over-the-counter pain medication. If you supplement your prescription with an over-the-counter pain reliever, you may overdose on the over-the-counter pain reliever.
The nature of the pain
Pain can be: girdle, stabbing, sharp, aggravated by coughing and breathing, covering half chest or part of it, radiate to the stomach, neck, arms. Metastasizing to the spine and limbs, the pain causes a lot of suffering. It can manifest itself in different ways and depends on the degree of damage to the parietal pleura, and at a later stage - the ribs and intercostal nerves. If at the beginning of its appearance it is mistaken for intercostal neuralgia, then when the ribs and spine are affected, the pain becomes especially painful, intense and practically does not stop, being poorly stopped by conventional analgesics.
It can cause problems with the liver, kidneys, and stomach. Addiction is very unlikely for cancer patients receiving pain medication under medical supervision. The dose is carefully adjusted to control pain. It is only when drugs are taken when there is no pain or above the level needed to control the pain that addiction can develop.
Do not chew on a pain reliever unless instructed to do so by your doctor. Most opioid pain medications come in slow-release tablets that provide a steady level of pain relief in your body until your next dose. Chewing pills can interfere with the delivery of the pain reliever and can lead to addiction.
When the apex is affected by a tumor and the pleura grows, moving to the nearby nerve brachial plexus, pain appears in the shoulder blade, in the shoulder, giving to the elbow joint, forearm and even the little finger. The patient experiences hyperesthesia (increased sensitivity) and a feeling of cold, muscle atrophy occurs. There is an increase in shortness of breath, respiratory discomfort, a failure in the heartbeat, chest pains like angina pectoris, accompanied by heart rhythm disturbances. The appearance of these symptoms indicates a far advanced process. However, many patients often cannot determine the source of origin.
If you forget to take your pain medication as directed, do not double your next dose. Taking more pain medication than needed to control the pain can lead to addiction. If pain medication doesn't control your pain, don't increase your dosage without talking to your doctor. Your doctor may want to increase your dosage or switch you to a different pain medication depending on the dosage. For example, if you are receiving pain medication through a patch, do not use additional patches at the same time, as this will not improve the pain and may be life threatening.
Until now, there is an opinion that the pain that occurs in the later stages of the disease cannot be eliminated. But today, in 90% of patients, it can be eliminated or its intensity reduced. To select an adequate analgesic therapy, it is necessary to take into account the sources and mechanisms of the origin of this symptom. Unfortunately, unjustifiably early prescribing of narcotic analgesics, and the use of excessive dosages, and non-compliance with the prescribing regimen are still allowed.
If you become depressed after stopping pain medication, tell your doctor. Depression is a sign of withdrawal, and your doctor may want to take you off the pain medication more gradually or give you a small dose to combat the withdrawal. In most cases, your doctor doesn't want you to stop taking your pain medication all of a sudden, but instead reduce your dosage gradually.
Other drugs for pain relief
After you are done with pain relief, you can return it to the pharmacy for safe removal. Do not flush it down the toilet or throw it in the trash. Pain after the end of treatment. It's not uncommon for cancer survivors to be more sensitive to every pain, pain, or bump and bruise they experience for a year or more after treatment ends. It's also unusual to worry about cancer coming back or getting another cancer. If something is bothering you, ask your oncologist or primary care doctor.
Pain treatment
Today there is a three-stage system of pain relief based on the recommendations of the World Institute of Pain - FIPP WIP, USA. The method consists in the use of analgesics of increasing action and adjuvant therapy. Moreover, the main principle is the beginning of therapy when the first manifestations of pain appear.
- Stage 1 - mild pain is stopped by non-steroidal anti-inflammatory drugs.
- Stage 2 - painkillers for lung cancer consist of a combination of weak opiates and non-narcotic analgesics (codeine, promedol, dionin, prosedol, tramadol, tramal).
- Stage 3 - narcotic analgesics are prescribed (omnopon, buprenorphine, morphine, fentanyl).
With pain therapy at any stage, drugs should be taken constantly, adhering to the hours of admission and the dose, which is adjusted, taking into account the intensity of the symptom.
Although cancer pain is usually treated medicines, surgery or radiotherapy, sometimes, in conjunction with these methods, rehabilitation, physical therapy, relaxation methods, etc. are used. In addition, nerve blockage is possible.
Most patients with cancer will one day experience pain that is caused by either the disease or its treatment. But some patients who have undergone therapy sometimes continue to suffer. Today, there are many drugs and methods for managing pain and discomfort, which can improve the quality of life of the patient, reduce and even prevent patient suffering.
