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Cancer pain, as the most common concomitant disease of cancer, brings tremendous physical and psychological harm to patients and their families

Cancer pain, as the most common concomitant disease of cancer, brings tremendous physical and psychological harm to patients and their families

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What is cancer pain?

What is cancer pain? What is cancer pain?

Pain is a person's physical, psychological, socialresults will influence each other, cultural and spiritual environment

Pain is a person's physical, psychological, social results will influence each other, cultural and spiritual environment

The best treatment goal for cancer pain is to reduce the pain to a level of acceptable quality of life for the patient

How to choose analgesics? How to choose analgesic drugs?

According to the degree of pain of the patient, different analgesic drugs are selected in a targeted manner

According to the degree of pain of the patient, different analgesic drugs are selected in a targeted manner

The first stage selection non-steroidal anti-inflammatory drugs ( nonste- roidal Anti-inflammatory Drug , NSAID is ); a first phase of selecting a non-steroidal anti-inflammatory drugs ( nonste- roidal Anti-inflammatory Drug , NSAID is );

The second stage if the NSAID can not relieve the pain, opioids can use weak orstrong opioids are low dose combination and NSAID ;

The second stage if the NSAID can not relieve the pain, opioids can use weak orstrong opioids are low doses, and the combination of NSAID ; second stage as if the NSAID can not relieve the pain, can use weak opioid or by Low-dose strong opioids, and can be combined with NSAID ;

The third stage: If the pain is still uncontrollable, strong opioids can be used, and NSAID can be combined

The third stage: If the pain is still uncontrollable, strong opioids can be used, and NSAID can be combined

In addition, three ladder drugs simultaneously , to follow condition selected tricyclic antidepressants or anticonvulsants drugs such adjuvant

Non-steroidal anti-inflammatory drugs ( NSAID )

Non-steroidal anti-inflammatory drugs ( NSAID ) Non-steroidal anti-inflammatory drugs ( NSAID )

NSAID mainly (by inhibition of cyclooxygenase COX-.

NSAID mainly (by inhibition of cyclooxygenase COX-.

Recommendations: ① Combination of misoprostol or proton pump inhibitors to preventpeptic ulcers or switch to selective COX‑2 inhibitors; ② Patients with cardiovascular diseases should try to avoid the combination with aspirin

Acetaminophen acetaminophen

Acetaminophen analgesic is mainly used for a first step, solution containing heat-inflammatory and analgesic effects have not function

Acetaminophen analgesic is mainly used for a first step, solution containing heat-inflammatory and analgesic effects have not function

Recommendation: ①Try not to use it in combination with opioids

Opioids opioids

Constipation is opioid analgesics intolerable adverse reactions should, generally opioid analgesia persists during treatment
.

Constipation is opioid analgesics intolerable adverse reactions should, generally opioid analgesia persists during treatment
.

Recommendation: ① During the use of opioids, combined use of laxatives (osmotic laxatives or stimulant laxatives) to prevent constipation , pay attention to the increase in the dose of opioids, but also increase the dose of laxatives
appropriately .
② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication reduced opioid dose
.
③If laxatives are not sufficient to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone
.
Recommended grade :
A .

Recommendations: ①In the course of opioid use, combined use of laxatives (osmotic laxatives or stimulant laxatives) to prevent constipation , pay attention to increase the dose of opioids and increase the dose of laxatives
appropriately .
② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication reduced opioid dose
.
③If laxatives are not enough to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone
.
Recommended grade :
A .
Recommendations: ①In the course of opioid use, combined use of laxatives (osmotic laxatives or stimulant laxatives) to prevent constipation , pay attention to increase the dose of opioids and increase the dose of laxatives
appropriately .
② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication reduced opioid dose
.
③If laxatives are not enough to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone
.
Recommended grade :
A .

Approximately 40% of patients may experience nausea after using opioids, and 15% to 25% of patients may experience vomiting
.

Approximately 40% of patients may experience nausea after using opioids, and 15% to 25% of patients may experience vomiting
.

Recommendations: ① When dealing with persistent nausea caused by opioids , increase therapies for different mechanisms of action, such as adding 5-HT receptor antagonists, scopolamine and other drugs to treat nausea
.
② intestinal obstruction blocking the patient is recommended olanzapine
.
③ Glucocorticoids are used in combination with metoclopramide and ondansetron
.
Recommended grade :
A .

Recommendations: ① When dealing with persistent nausea caused by opioids , increase therapies for different mechanisms of action, such as adding 5-HT receptor antagonists, scopolamine and other drugs to treat nausea
.
② intestinal obstruction blocking the patient is recommended olanzapine
.
③ Glucocorticoids are used in combination with metoclopramide and ondansetron
.
Recommended grade :
A .
Recommendations: ① When dealing with persistent nausea caused by opioids , increase therapies for different mechanisms of action, such as adding 5-HT receptor antagonists, scopolamine and other drugs to treat nausea
.
② intestinal obstruction blocking the patient is recommended olanzapine
.
③ Glucocorticoids are used in combination with metoclopramide and ondansetron
.
Recommended grade :
A .

Opioids on the central sedative effect, can be suppressed brainstem preBötzinger composite produced respiratory rhythm raw, can easily cause the patient's respiratory depression, opioid main reason of death
.

Opioids on the central sedative effect, can be suppressed brainstem preBötzinger composite produced respiratory rhythm raw, can easily cause the patient's respiratory depression, opioid main reason of death
.

Recommendations: ①The overall symptoms of the patient are stable, non-invasive respiratory support should be given, and the patient's symptoms should be closely monitored
.
②If the patient is in poor condition, naloxone is used to relieve symptoms
.
Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
1 ml ), each 30 to 60 to the second .
1 ~ 2 ml , until the patient 's symptoms improved
.
③ to accept the need for long-term opioid patients were treated, while taking naloxone considered to reduce the risk if necessary
.
Recommended grade :
A .

Recommendations: ①The overall symptoms of the patient are stable, non-invasive respiratory support should be given, and the patient's symptoms should be closely monitored
.
②If the patient is in poor condition, naloxone is used to relieve symptoms
.
Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
1 ml ), each 30 to 60 to the second .
1 ~ 2 ml , until the patient 's symptoms improved
.
③ to accept the need for long-term opioid patients were treated, while taking naloxone considered to reduce the risk if necessary
.
Recommended grade :
A .
Recommendations: ①The overall symptoms of the patient are stable, non-invasive respiratory support should be given, and the patient's symptoms should be closely monitored
.
②If the patient is in poor condition, naloxone is used to relieve symptoms
.
Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
1 ml ), each 30 to 60 to the second .
1 ~ 2 ml , until the patient 's symptoms improved
.
③ to accept the need for long-term opioid patients were treated, while taking naloxone consider, if necessary, to reduce the risk
.
Recommended grade :
A .

Neurotoxicity ( OIN ) ranging from excessive sleepiness (sedation) to hallucinations, delirium, muscle array twin, seizures and hyperalgesia
.

Neurotoxicity ( OIN ) ranging from excessive sleepiness (sedation) to hallucinations, delirium, muscle array twin, seizures and hyperalgesia
.

Recommendation: ①For patients with OIN , it is recommended to change opioids or reduce the dose
.
②For patients with delirium who require medical intervention , consider risperidone 0.
25 to 0.
5 mg , 1 to 2 times a
day .
For Parkinson's patients, consider using quetiapine
.
③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
.
Recommended grade :
B .

Recommendation: ①For patients with OIN , it is recommended to change opioids or reduce the dose
.
②For patients with delirium who require medical intervention , consider risperidone 0.
25 to 0.
5 mg , 1 to 2 times a
day .
For Parkinson's patients, consider using quetiapine
.
③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
.
Recommended grade :
B .
Recommendation: ①For patients with OIN , it is recommended to change opioids or reduce the dose
.
②For patients with delirium who require medical intervention , consider risperidone 0.
25 to 0.
5 mg , 1 to 2 times a
day .
For Parkinson's patients, consider using quetiapine
.
③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
.
Recommended grade :
B .

10% to 50% of patients taking opioids initially occur after drug symptoms of pruritus, especially in the neuraxis resistance hysteresis, but generally stable opioid doses 2 weeks after symptoms subside
.
In addition μ outer opioid receptors .
5-the HT and D2 receptors, the forefront of gonadotropins and spinal inhibitory pathways may be involved in the occurrence of pruritus
.

10% to 50% of patients taking opioids initially occur after drug symptoms of pruritus, especially in the neuraxis resistance hysteresis, but generally stable opioid doses 2 weeks after symptoms subside
.
In addition μ outer opioid receptors .
5-the HT and D2 receptors, the forefront of gonadotropins and spinal inhibitory pathways may be involved in the occurrence of pruritus
.

Recommended: ① If the skin itching symptoms persist, it is recommended conversion A piece drugs
.
Opioid agonists or mixed carefully titrated - antagonists (e.
g.
sodium nalbuphine) or the opioid receptor antagonist (e.
g.
, naloxone )  
.
② sheath for itchy skin caused by anesthesia in the patient may try to use ondansetron Joan therapy
.
Recommended grade :
A .

Recommended: ① If the skin itching symptoms persist, it is recommended conversion A piece drugs
.
Opioid agonists or mixed carefully titrated - antagonists (e.
g.
sodium nalbuphine) or the opioid receptor antagonist (e.
g.
, naloxone )  
.
② sheath for itchy skin caused by anesthesia in the patient may try to use ondansetron Joan therapy
.
Recommended grade :
A .
Recommended: ① If the skin itching symptoms persist, it is recommended conversion A piece drugs
.
Opioid agonists or mixed carefully titrated - antagonists (e.
g.
sodium nalbuphine) or the opioid receptor antagonist (e.
g.
, naloxone )   .
② sheath for itchy skin caused by anesthesia in the patient may try to use ondansetron Joan therapy .
Recommended grade : A .
 

Dose long-term opioid therapy may increase could lead to opioid-induced hyperalgesia, leading to pain aggravate rather than alleviate the pain
.

Dose long-term opioid therapy may increase could lead to opioid-induced hyperalgesia, leading to pain aggravate rather than alleviate the pain
.

Recommended: ① plus adjuvant to the pharmaceutical art nerve block or reduce small amounts of opioid
.
②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan
.
Recommended grade :
B .

Recommended: ① plus adjuvant to the pharmaceutical art nerve block or reduce small amounts of opioid
.
②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan
.
Recommended grade :
B .
Recommended: ① plus adjuvant to the pharmaceutical art nerve block or reduce small amounts of opioid
.
②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan
.
Recommended grade :
B .

Receiving chronic opioid analgesic therapy patient 's immune system is often suppressed, and further the outer circumference depletion of endogenous opioid analgesic acting substance mediated decrease opioid analgesic function
.

Receiving chronic opioid analgesic therapy patient 's immune system is often suppressed, and further the outer circumference depletion of endogenous opioid analgesic acting substance mediated decrease opioid analgesic function
.

Recommendations: ①Choose non-opioid-dependent treatment options
such as nerve block technology .
② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl and the like veneer
.
Recommended grade :
C .

Recommendations: ①Choose non-opioid-dependent treatment options
such as nerve block technology .
② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl and the like veneer
.
Recommended grade :
C .
Recommendations: ①Choose non-opioid-dependent treatment options
such as nerve block technology .
② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl and the like veneer
.
Recommended grade :
C .

Opioids mainly affect the endocrine system through the HPA axis.
Hypogonadism is currently one of the recognized adverse reactions.
At the same time, the use of opioids may cause hyperprolactinemia and cause bone metabolism disorders
.

Opioids mainly affect the endocrine system through the HPA axis.
Hypogonadism is currently one of the recognized adverse reactions.
At the same time, the use of opioids may cause hyperprolactinemia and cause bone metabolism disorders
.

Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
.
Recommended grade :
A .

Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
.
Recommended grade :
A .
Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
.
Recommended grade :
A .

Opioid drug dependence because of their characteristics has been strictly regulated for patients, drug dependence is likely to cause withdrawal symptoms are likely to cause an opioid drug abuse and even poisoning, overdose were triad
.

Opioid drug dependence because of their characteristics has been strictly regulated for patients, drug dependence is likely to cause withdrawal symptoms are likely to cause an opioid drug abuse and even poisoning, overdose were triad
.

Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients
.
② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue
.
Recommended grade :
A .

Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients
.
② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue
.
Recommended grade :
A .
Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients
.
② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue
.
Recommended grade :
A .

Reference

References
References

1.
Chinese Anti-Cancer Association Professional Committee on Nutrition tumor .
Adverse drug reactions analgesic expert consensus .
Tumor metabolism and electronic Journal of Nutrition 2021 Nian 4 Yue 9 on May 8 , Volume 2 Qi

1.
Chinese Anti-Cancer Association Professional Committee on Nutrition tumor .
Expert consensus analgesic adverse drug reactions .
Tumor metabolism and electronic Journal of Nutrition 2021 Nian 4 Yue 9 Ri on 8 Volume 2 Qi 1.
Chinese Anti-Cancer Association Professional Committee cancer nutrition .
Analgesic adverse drug reactions expert consensus .
tumor metabolism and electronic Journal of nutrition 2021 Nian 4 Yue 9 Ri on 8 volume 2 Qi

2.
The three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder.
https://professionals.
wrha.
mb.
ca/old/professionals/files/PDTip_AnalgesicLadder.
pdf

2.
The three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder.
https://professionals.
wrha.
mb.
ca/old/professionals/files/PDTip_AnalgesicLadder.
pdf 2.
The Three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder.
https://professionals.
wrha.
mb.
ca/old/professionals/files/PDTip_AnalgesicLadder.
pdfLeave a

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