Cancer analgesia is extremely important in cancer treatment. In the advanced stage of cancer, 70-80% of patients will experience pain of varying degrees. For cancer pain, the country has special advanced cancer pain Treatment guidelines are used to guide clinicians to standardize and effectively treat patients with pain. Effective pain relief can significantly improve the quality of life of patients and prolong the survival time of patients to a certain extent. There are relatively many patients suffering from pain in advanced stage of liver cancer, so timely, effective and standardized analgesic treatment is required.
Currently, in the treatment of cancer pain, the three-step analgesic method is still followed, that is, after a correct assessment of the nature and cause of cancer pain, an appropriate choice should be made according to the degree and cause of the patient’s pain. Corresponding analgesics, all cancers follow this principle, and liver cancer is no exception. In advanced stage of liver cancer, the pain site is generally the local pain of the right upper quadrant liver tumor, or the pain caused by the metastases. The nature of the pain will be different in different parts, which can be dull pain and swelling pain in the internal organs, or bone metastases or nerve compression. Sharp pain.
Commonly used medications include:
The first step painkillers are non-steroidal anti-inflammatory painkillers, such as oral ibuprofen, Voltaren, Sanlitong, Yingtaiqing, etc. Intravenous or intramuscular injections include flurbiprofen axetil and ketorolac tromethamine, which have positive effects on bone and soft tissue pain, no drug resistance and dependence, have capping effect, and have many side effects, especially digestive tract reactions. and liver damage, do not blindly increase the dose;
Second-step drugs for moderate pain, i.e. weak opioids, such as codeine, tramadol, dezocine, etc., also have a maximum dose limit ;
Third-step drugs for severe pain, that is, strong opioids, without capping effect, the dose should be titrated before use, commonly used morphine controlled-release drugs , Oxycodone sustained-release tablets, fentanyl transdermal patches, morphine rectal suppositories, etc., the possibility of addiction is extremely small when used correctly.
Five principles must be followed during use, Non-invasive administration (oral, patch, rectal suppository) is preferred, and administration is done on time rather than when the pain is severe , three-step drug delivery, individualized medicine, attention to detail. As long as these 5 principles are followed in a standardized manner, 80% of patients can get effective analgesia.
In addition, analgesics alone are sometimes ineffective, and adjunctive analgesics, including antidepressants such as amitriptyline, may be added depending on the pain condition. , Doxetine, anticonvulsants such as carbamazepine, gabapentin, etc. For bone metastases pain, a combination of NSAIDs, opioids, and bisphosphonates can be used for better results.
Nowadays, in many hospitals, patient-controlled analgesia technology has also been applied to a certain extent. The patient-controlled analgesia device consists of three parts: the drug storage pump, the compression device and the connection catheter. The route of administration can be intravenous or subcutaneous, and the most commonly used drug is sufentanil. Patient-controlled analgesia pumps for cancer pain patients usually set a continuous infusion volume and a single dose. Continuous infusion is controlled by a microcomputer, and a single dose is administered by the patient himself if he still feels pain on the basis of continuous administration. The self-controlled pump is easy to use, and the pain relief effect is relatively stable.
For patients with liver cancer who have poor response to three-step analgesics or who cannot tolerate toxic and side effects, analgesia beyond the three-step analgesia can also be considered, including nerve block and Destruction, spinal cord stimulation, central target-controlled analgesia (programmable morphine pump technology), etc. This type of treatment is usually performed in the analgesia department of a general hospital.