Cancer patients have no limits on morphine use

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peopleClass for fear of cancer, not only from the disease will devour our lives, in fact, is largely caused by chronic fear of cancer, treme

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people

Class for fear of cancer, not only from the disease will devour our lives, in fact, is largely caused by chronic fear of cancer, tremendous physical and mental suffering, and pain is the main culprit. The majority of patients

A. Thankfully, in 1998 the State Food and Drug Administration issued the No. 160 document pointed out: "the use of morphine from morphine maximal cancer patients, limit the use of opioids for pain of patients brought the gospel. Cancer pain is cancer, cancer related lesions

Pain caused by anticancer therapy. Cancer pain is often chronic pain. The pain in patients with advanced cancer incidence rate of about 60% - 80%, which 1/3 for severe pain. Cancer pain patients may survive for months or years if

Can not get the appropriate treatment of pain, the quality of life of patients and their families will have a very serious impact. WHO (WHO) has proposed the "three step analgesic ladder for cancer", that is, non steroidal anti-inflammatory drugs, weak opioids

And the strong opioid ladder three, on behalf of their drug is aspirin, codeine and morphine, according to clinical pain light, medium and heavy degree gradually by ladder analgesic drug selection. Opioids are currently the most potent analgesic drugs and do not have a "ceiling""

The effect (when the dose is more than the usual dose can lead to an increase in adverse reactions, but the treatment does not increase), the analgesic effect increases with the increase of dose, so there is no so-called maximum or best dose. For individual patients

The optimal dose is determined by the balance between analgesia and tolerable adverse reactions. In particular, WHO is recommended as a representative drug for the relief of severe pain, and even the use of morphine consumption as a measure of cancer three steps

An important indicator of the implementation of the pain program. From the 90s of last century, developed countries have been widely used morphine, its annual consumption of more than 10mg. While in China, codeine and pethidine (Demerol) is China's most

Commonly used narcotic drugs, morphine has not been widely used. After statistics, China's per capita consumption of morphine rose to 0.195mg/ in 2002, there is a big gap with the developed countries! Why, then, would people be reluctant to accept morphine with better analgesic effects? Let us try to understand the application of cancer medications what errors. Myth: non opioid analog safer

In fact, the need for long-term analgesic drug treatment of patients, opioid use is more safe and effective, it is important to correctly control the dosage titration, drugs may produce adverse reactions, long-term use of liver and kidney etc.

Non toxic effects of organs. The long-term use of non steroidal drugs can cause gastrointestinal and renal toxicity, and significantly inhibit platelet function. Large doses of acetaminophen can cause liver toxicity. Myth two: only when the pain is severe, the use of analgesics, pain relief after medication can be partially

In fact, the purpose of analgesic treatment is to relieve pain, improve function, improve the quality of life. Painless sleep is the minimum requirement for analgesia, the ideal analgesic treatment in addition to reach this goal, but also for patients to achieve painless rest

And the goal of painless activities in order to achieve the purpose of improving the quality of life of patients. In addition, long-term pain will cause a series of disease physiology

Changes affect people's emotional and mental health, even due to pain caused by neuropathic pain associated with sympathetic nerve dysfunction, manifested as hyperalgesia and allodynia and intractable pain. Therefore, in patients with pain, in a timely manner, timely use of analgesic drugs is more safe and effective, the intensity and dose of analgesic drugs is also required. Myth three: the use of opioid drugs vomiting, sedation and other adverse reactions, should immediately stop the fact that, in addition to constipation, opioid adverse reactions are mostly temporary or tolerable. Vomiting, sedation and other adverse reactions generally occur only in the first few days of medication, a few days after the symptoms disappear. To prevent and avoid the occurrence of adverse reactions in the treatment of opioid adverse reactions. Misunderstanding four: the use of pethidine analgesia is safe and effective in medicine, WHO has pethidine as the treatment of cancer pain medication is not recommended, the analgesic effect of morphine is only 1/10; and its metabolite normeperidine long half-life, can cause neurotoxicity and nephrotoxicity; other pethidine oral bioavailability the difference, by intramuscular injection, is not conducive to the treatment of chronic pain. Myth five: the long-term use of opioid analgesics will inevitably be addicted to addiction, is a primary, chronic, neurobiological disease

Genetic, psychosocial and environmental factors can influence the generation and clinical manifestations of addiction. The characteristics of the behavior include: drug out of control, compulsive medication, to continue to use drugs and a strong desire for drugs, etc.. In fact, long-term use

Opioid analgesics in the treatment of cancer pain, especially oral or transdermal drug administration on time, addiction (mental dependence) the risk is minimal. In the past forty years, domestic and foreign clinical studies have shown that opioids have a risk of mental dependence

Risk is lower than 4/10000, it should be said that cancer patients opioid addiction is very rare. It should be noted that some patients because of pain control is not enough, showing a similar drug addiction behavior, once the pain is controlled

Stopping, increasing the dose of the drug often helps the patient to get rid of this behavior. It is easy to be mistaken for this kind of patient, and be treated unfairly. Misunderstanding six: only end-stage cancer patients to use the maximum tolerated dose of opioid analgesic drugs as a matter of fact, the dosage of opioids, there are great differences in different patients, and opioid analgesics without cap effect, the dose should be considered to determine the individual patient, the best dose should be reached between the best analgesic effect and adverse reaction of tolerance balance. The maximum tolerated dose of opioid analgesics may be used in patients with any major pain, regardless of the clinical stage of the tumor and the expected survival time. Myth seven: once the use of opioid drugs, it may be a lifelong need to use drugs, in fact, as long as the pain is satisfied with the control, you can always safely disable opioid analgesics or non opioid drugs. When the daily dose of morphine was between 30 and 60mg, there was no accident. Long term high dose of medication, sudden withdrawal of withdrawal syndrome may occur, it is recommended for patients with long-term large dose of drug withdrawal. Myth eight: opioids can inhibit breathing in the acute phase of the use of opioids may produce significant respiratory depression, especially those who have been treated with opioid treatment is more serious. But for 5-7 days, patients usually can produce tolerance to respiratory depression, and will not produce analgesic tolerance, which is one of the characteristics of opioid drugs for long-term treatment. Misunderstanding nine: opiods intramuscular or intravenous than oral (transdermal) effective opioid therapy is decided as a matter of fact, the drug concentration of opioid receptor level, rather than the route of administration. Intramuscular or intravenous injection has the advantages of faster onset or for dose titration (dose adjustment), rather than the long-term medication of choice. All in all, the traditional understanding of the limitations caused not extensive, standardized application of morphine in cancer patients, currently only 41% of patients with cancer pain has been effectively alleviated, China clinical situation of standardized treatment of cancer pain is not optimistic. It is the responsibility of the medical staff and the humanitarian duty of the whole society to make cancer patients without pain.

 

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