Pain is an unpleasant or intolerable subjective sensation, function, or behavioral change in the body. The pain in medicine include: cancer
Pain is an unpleasant or intolerable subjective sensation, function, or behavioral change in the body. The pain in medicine include: cancer pain, chronic strain and aseptic inflammation caused by pain (such as lumbar muscle strain), postoperative pain, labor pain, nerve pain etc.. Today we're talking about cancer pain. Cancer pain, and cancer related pain as the name suggests, will be about 70% again in the course of cancer patients. What caused pain? About 78% of the mass in itself, tumor compression, invasion and metastasis of bone, nerve and other organs are the most common causes of cancer, such as fading, constipation, bedsore and other physical condition will cause pain. It is worth noting that some mental status changes, such as fear, anxiety, anger, loneliness and other factors can also cause or aggravate the pain. Pain is a kind of torture to patients and their families, only pain with satisfactory treatment, quality of life and physical and mental state of the patients can be improved to more effective treatment of the disease itself. "Pain relief is a fundamental human right for patients," the second Asia Pacific Conference on pain control in 2001 showed that the medical profession has improved the treatment of pain to an important position.
Combined with clinical practice, we found that the pain in China is far from enough to get attention and treatment of cancer pain treatment, we still stay in the developed countries, the level of 20 years ago. In this situation the main reason for the following three aspects: one is the concept of medical workers is not correct, the pain is not enough, two is the administrative department for medicine management is not reasonable, such as the patient was discharged from hospital after it is very difficult to channel analgesic drugs, drug costs, analgesic drugs not popular in the town of junior hospital, three patients and family education, patients and their families have many concerns about pain treatment, and the social and medical institutions, especially medical institutions for patient education is not in place of a great relationship, this is the work of medical staff on a blind spot. For example, I often see this phenomenon in the clinic, a patient in the treatment of cancer pain by use of analgesic drugs, gradually feel 12 hours 1 analgesic effect decreased, the doctor asked him to add quantity but does not explain why dosage, patients feel worse, also feel the doctor just put him in the. In the doctor-patient relationship from, do not know whether you had this kind of experience. In fact, if the patient understands the characteristics of these analgesics that we are going to talk about, there will be no misunderstanding. There is no doubt that as a patient's right to know the relevant information for the treatment of disease, the doctor asked him to check every patient with detailed explanation, in time is not realistic, the good doctor must have time to continue learning, to enrich themselves, to ensure to give the patient is in reality help not just empty comfort. Therefore, we call everyone to do a detailed instruction on the related knowledge of cancer pain treatment today, hoping to focus on the treatment of cancer pain to bring you the correct idea of doctors work together to pain.
My today's content is divided into the following several parts: first, how to evaluate the pain (0-10 grade), two methods of treatment, pain in three, what are the commonly used painkillers, how to use, what are the adverse reaction, four patients, how to cooperate with the doctors for pain treatment, five families can play what role in pain treatment.
A pain assessment.
Why is the assessment of pain? Because the patient pain is a subjective feeling, it is difficult to accurately understand the feelings of patients, there is a need for a method of the patient's feelings into a specific number, so that doctors can understand the degree of pain, so as to use of pain medication at different levels, and the pain intensity after medication change is painkillers have a correct understanding.
The clinical assessment of cancer pain is the most commonly used 0-10 classification method, which is defined as painless zero, the pain is defined as 10, give yourself the pain score, divided by the degree of pain, to help doctors to use painkillers. For example, one of the patients of lung cancer involving the chest muscles, in the early stage of invasion is to a lesser extent, cause sometimes no local pain, does not affect sleep, activity can slightly relieve, this usually is the score of 1-3 for mild pain. If the exacerbation, the pain caused by persistent, but sometimes slightly reduced, and sometimes affect sleep, then usually rated 4-6 points, moderate pain. If the further development of the rib caused by the destruction of pain does not ease the continued existence of the impact of activities and sleep, or even wake up after sleep pain, scoring up to 7-10 points, for severe pain. Patients learn to assess the degree of pain will enable doctors to better access to the real situation of the pain to avoid human bias. The level of medication used for different levels of pain is not the same, which will be described in the following.
Two, the treatment of cancer pain
Pain, is pain caused by cancer. Treatment of cancer pain is divided into 2 categories, namely for tumor treatment and relief of symptoms in palliative care. For cancer treatment is surgery, radiotherapy, chemotherapy, tumor size, and because of the pain caused by natural ease, but many side reactions such as patients without surgery, when chemotherapy has failed or the physical condition of the patient cannot tolerate tumor treatment, then can only choose to relieve symptoms in palliative care. The main method is to use pain medication, which is to be discussed in the following.
Three, commonly used painkillers which, how to use, what adverse reactions
Just as a very important means of treatment of cancer pain, pain medication. So what are the existing analgesic drugs, how to use, what are the adverse reactions? We are most concerned about opioid painkillers exactly what is going on? What is the value of clinical application? At present, the clinical analgesic drugs can be divided into 3 types: mild pain, moderate pain, severe pain medication, apply to mild, moderate, severe pain. This should also prove why the church in front of the pain assessment. Mild pain, severe pain medication is overkill, severe pain with mild pain is the best effect only attempt an ineffective solution, for the drugs to. Almost everyone had mild pain, as long as you had a cold, cold medicine containing acetaminophen is the most commonly used clinical mild analgesics can relieve cold headache, sore throat, headache, but cancer is moderate to severe headache, so we focus on the introduction of moderate and severe pain. Tramadol -- brand name Chimandin, many people have heard may also be used, this is one of the most commonly used clinical moderate analgesics, the drug 1 continuous pain 12 hours, so the doctor will suggest that you eat every 12 hours. The adverse reactions mild, some people just eat the first 1-2 days there will be nausea and vomiting feeling, and with continued treatment will naturally disappear, some medication can cause constipation, dry stool, difficult to discharge, then add some laxative drugs or food can often ease. For patients with moderate pain tramcontin, re review, moderate pain refers to pain but also can barely stand, can barely sleep at night, if there is severe pain, which seriously affect the life, difficult to sleep, even asleep woke up from the pain, then the possibility of moderate analgesic effective analgesia is very small, then the ills to use you need to direct the use of severe illness, pain, that is we often say that morphine. This is the patients and their families are most concerned about is the most easy to Chinese conflict, opium damage is entrenched, now opium upgrades - white, we are all called drug ecstasy, and spread in the community, leading to a family tragedy, no wonder a talk about the color. But things always have two sides, we all know that morphine from poppies, and the earliest poppy growers is the good analgesic effect and as a medicine to grow, which recorded in Li Shizhen's "Compendium of Materia Medica" has been, people's long-standing visible use of morphine. Modern medicine has been continuous purification of morphine drugs, improved, for example, has been able to do so in a slow release of morphine drugs in the human body, rarely produce euphoria, can overcome the psychological addiction. The same is the difference between morphine, drugs, and drugs. It can be said that as long as the doctor in strict accordance with the doctor's advice, the possibility of the occurrence of morphine addiction is negligible. So what are the commonly used morphine drugs used in clinical analgesic therapy? Below we will select 2 of the most representative of the drug is also the most widely used drugs to introduce. One is Morphine Sulfate Sustained-release Tabelets, the United States and Kangding. This is a standard morphine drugs, each drug can be sustained in the body for 12 hours, blood drug concentration is constant, analgesic effect is strong and durable, mainly for severe pain. The normal use of the method is to take orally every 12 hours, each time according to the extent of the doctor to determine the degree of pain, the doctor will be based on the intensity of pain and analgesic effect in 2-3 days to adjust the drug to the best dose. The pain score was controlled within 3 minutes. If the progress of the disease or other causes of pain in the medication again, can be adjusted to increase the amount of painkillers, but must comply with the doctor's request, to avoid their own blindly indiscriminate. There is no maximum dose of morphine in theory, and it can increase with the pain. It is reported a daily dose of more than 1 thousand mg, equivalent to us Kangding 30-40 / day, we used the maximum dose 1 days 20 or so, this is the 1 of patients with advanced colon cancer, after treatment of pain control is better, before dying to minimize the pain caused by the pain, maintain a human dignity. Morphine drugs play a role in pain relief, but also in addition to the role of pain relief in addition to other functions, medically referred to as adverse reactions, the following to introduce you. The most common adverse reactions were constipation after medication, some patients will appear dry stool, difficult. For this part of patients need to use laxative drugs with no Maren Pills, phenolphthalein tablets, after general treatment most of the symptoms of constipation can be alleviated. However, it should be noted that, once the emergence of constipation, laxative drugs need to be accompanied by the use of painkillers, unauthorized withdrawal of drugs may increase constipation. Another common adverse reactions were transient nausea and vomiting, a few medication within 24 hours after the nausea and vomiting, but with medication continues, these symptoms may disappear, do not need to do more processing, which is why the cause of vomiting after the doctor will encourage patients to continue medication. The above two kinds of reactions accounted for about 80% of clinical adverse reactions, so the safety of this drug is very high. Other rare reactions include drowsiness, retention of urine, and so on. These reactions appear to be relatively low and should be immediately reported to the doctor for treatment. To introduce a kind of commonly used analgesic drugs, oxycodone hydrochloride controlled-release tablets, brand names like Kangding. The drug has been improved on the basis of morphine and has better effect and less adverse reaction. His maintenance time is 12 hours
Four, patients should be how to cooperate with the doctor for pain treatment
Here we are going to talk about how patients with medical treatment, we always say: you want to make the rounds with medical treatment, but how to cooperate with the doctor in the treatment of pain? Mainly to dispel some of the concerns of treatment, establish the correct concept of pain treatment. From the preliminary questionnaire survey, we summarize and analyze several common patient concerns, hoping to help patients reduce unnecessary worries.
The biggest worry is the use of painkillers. Medicine addiction is divided into mental and physical dependence, the former refers to the spirit cannot do without the drug, in no case of drugs will do anything to get the drug, the latter refers to the use of painkillers to a certain dose after the sudden withdrawal after a series of uncomfortable body reaction. I can responsibly tell you that as long as the use of a reasonable dose of medication and adjust the dose, oral analgesics, especially the possibility of drug addiction is minimal. The spirit of addiction is a common manifestation of drug addicts, in intravenous medication, clinical medical treatment in our department in recent 7 years, oral medication did not cause patient psychological addiction, reported in the literature, the spirit of addiction can be found in various reasons can not be converted to oral vein analgesic use cases, and is often associated with the medication is not standardized about. The use of pain medication when pain medication, no pain on the withdrawal, it is easy to form a medication and the pain of the conditioned reflex, resulting in mental dependence. Another dependence on drugs - physical dependence refers to a series of physical reactions, such as sweating, general malaise, diarrhea, etc.. The same can be achieved by reasonable arrangements to avoid medication, in the withdrawal of the drug through a gradual reduction in dose rather than a sudden withdrawal can minimize physical dependence. In my 7 years of clinical work, I have seen a typical case of the 1, through the adjustment of the drugs have been well controlled. This is a case of cancer of the digestive tract, oral 1 days more than 10 beautiful Shi Kangding, pain control satisfaction, then the progression of intestinal obstruction, fasting caused us Kangding sudden withdrawal, the body reaction irritability, sweating, body discomfort, diarrhea, consider morphine drugs caused by sudden withdrawal physical dependence, underwent rectal administration, when the dosage of oral dosage is the pain control again disappeared gradually. From our years of clinical practice, I found that patients in China need to overcome the bias of morphine drugs, reasonable, regular medication according to the doctor's orders, to get a better quality of life.
Another concern is that the growing amount of morphine drugs can cause the economy to suffer. There is an objective need for morphine drugs to be added in the course of medication. Even if the condition is not in use of morphine like drugs will appear after a period of time the original dose of analgesic effect is reduced, resulting in the need to increase the drug dose to achieve pain control phenomenon, medicine called "tolerance". This is a normal medical phenomenon, some patients regard this phenomenon as addiction is not correct. This phenomenon itself does not cause adverse effects on patients, but will increase the dosage of the drug, the corresponding increase in the economic burden of treatment. Morphine analgesics about 9 yuan, about $1, according to the usual amount of 2-4 tablets / day, a month is 500-1000 yuan, for many families, long-term use is not a small number of. The Nanchang patient, Li Jiacheng fund in our province with hospice, economic difficulties for cancer patients free of pain medication, but the procedure is very complicated, and the need to ensure the flow of drugs regularly. For the majority of patients outside the city of Nanchang, especially in rural areas, there is no such charity projects, if you need long-term medication, you can apply to the local county hospital anesthesia card clinic can buy drugs. For patients who are not well off, I suggest that if the current economic capacity is difficult to support cancer treatment, the limited money will be used to improve the quality of life, as far as possible to ensure the cost of pain treatment. For example, a severe pain in patients with advanced cancer, financial constraints, can only come up with 6000 yuan treatment, is to take this $6000 to play a chemotherapy on the home, or take these 6000 hospitals to ensure the supply of painkillers for 6 months? The answer is obvious. A maximum of 1 months of chemotherapy can control the disease, 1 months after the patient is suffering, in the endless pain in the pain of the patient, the family worried, but if used for pain treatment, then at least half a year does not need to endure the pain of torture, to maintain the dignity at least. The economic problem is a realistic problem that can not be avoided. In the limited economic condition, how to distribute it will be related to the vital interests of the patient.
In addition, the patient's common concerns and concerns about drug side effects, which have been elaborated in the previous narrative.
Five, family members in the role of pain treatment
Family members are the closest to the patient, but also the spiritual pillar of the patient. After the disease, especially cancer, the disease will change the mentality of. Even if the original is the arrogance of the people will also have a worry, fear will be tired and give up their family. Some of the families of patients will behave very dependent, but some people will be on the surface to conceal her this dependence, so as to the families of temper, fault, but this is the inner expression of fear. Especially for the presence of cancer pain patients, pain enough to make a usually very meek became cranky rude, at this time, family members should be aware of the psychological characteristics of the patients, more attention and encouragement. Family members should actively communicate with the doctor, first of all to establish the correct concept of pain treatment, and then with the doctor to persuade the patient, so that it can be treated in accordance with the doctor's request for reasonable treatment. The doctor may not have a lot of time and a patient together every day, and the family is the most understand the patient, understand the patient's personality, understand the patient's request, a wise family should be able to establish a cooperative relationship with the doctor. In the ward shows, I fear most is when the patient met the families, said yesterday that the analgesic effect is not very good, the family immediately beside with "yes, eat or the same pain, this pain what time to good, good won it, this drug is a drug." some said, "this disease is a waste of money". Such a family can only make the patient and the doctor in opposition, and in the end is really spent money to cure. In short, combined with my clinical experience, it is recommended that the family to do the following: 1, do not complain in front of the patient, complaining about the money spent, the disease is not good, so that patients have a good mood. There is no money, and the patient can honestly discuss, complaining is not cure. Excuse me, 2 patient's bad temper, put it as a child, and he don't care. In fact, I love many families to temper the patient privately about the heart is very attached to their families, the families understand also pay, just because the heart trouble to vent, only to find their closest people, to the close, the families would excuse me some of it, maybe some years later, again excuse me have no chance. 3, the doctor and frank exchanges, "how to spend money not cure the disease, the family is no money", these words do not of the patient to nag, but can communicate with your doctor, doctor is to believe will really help you, and can communicate with the doctor, to discuss the best treatment. Mutual respect, mutual trust is a prerequisite for the harmonious coexistence between people, the same applies to the relationship between doctors and patients.
The above is the entire contents of today pain knowledge, hoping to help you or your family, if there is what matters, welcome to talk privately.