In the cancer patient's subjective symptom, the ache formation rate is highest. The patient's condition patient has 40% to be accompanied by the ache at least. The terminal cancer patient 80% have at least moderate to the specific weight ache. According to the statistical data indicated: Because the world year has 2,500,000 people cancer ache not to be able to obtain the prompt treatment to die. In the world has 3,500,000 people every day, in cancer ache suffers gets by difficultly. The ache not only does not favor the ache the treatment. Also increased the pain to the patient. Reduced patient's survival quality obviously. First, in idea renewal The medical personnel, the patient, the public, the family member to ache understanding, manner, expectation as well as to ache treatment, nursing have had the huge change in the past's more than 30 years. Now, cancer patient's ache question obtained the entire community public figures to take seriously. Takes each kind of remedial measure decisively to cancer ache patient, high method relieves patient's pain, improved patient's survival quality, the extension life new idea has substituted for in cancer ache treatment traditional ideas gradually. But, are many expert to believe at present, the hindrance stops pain effectively the subject matter is not only nurse lacks the understanding to the anaesthetic pharmacological action, moreover, knows the insufficiency to person's life quality and the nursing job category itself. Doctor and nurse worried generally the patient uses the anaesthetic to be able to reappear the spiritual dependence, and the family member also harbors the dread including the patient himself to the anaesthetic. Presents “four does not hope the syndrome”, namely doctor is not willing the sufficiency the pain-killer, the pharmacy not to be willing to send the sufficiency the medicine, nurse/the family member is not willing to give the sufficiency the medicine, the patient is not willing to accept the sufficiency the pain-killer. Therefore not only needs the medical personnel regarding cancer ache's treatment to know that on the renewal, needs the patient and family member's coordination, particularly patient family member's cooperation. Second, family member's function Undeniably, cancer patient many are stays in hospital the treatment in the hospital, but, also had quite a partial cancer patient to pass after all in the home. Therefore, in cancer ache's treatment, the family member is also undertaking the very important responsibility. And includes: 1st, estimates reliably correctly patient's ache, assists the medical personnel to work out the reasonable therapeutic schedule. The patient ache estimates its content including the ache degree, the spot, the nature, the outbreak situation and the complication and so on. Family member when estimate patient's ache, must pay attention to the psychology, the society and the economy besides the bodily factor and so on various factors influence. 2nd, accurate, gives the phial bottle observation pain-relieving medicine promptly the effect and the side effect. 3rd, comforts for the patient, explains and encourages, to enable it to get rid from the spirit to the ache the fear, increases to the life the hope. 4th, the education and the explanation change for the patient to the medicine side effect and the tolerant wrong understanding, encourages the patient to enjoy person's dignity and person's authority. Third, family member's duty In the cancerous ache treatment's process, the role which its family member plays is unwise to underestimate, they need to complete the massive nursing work. Therefore, they must understand and grasp nursing the scope. 1st, understanding cancerous ache treatment basic principle: (1) grasps some effective, the main control ache medicine dosage and the applicable scope truly. (2) the pain-killer heart possibly takes orally, next, is the rectum medication, finally only then chooses the injection. The medicine use should follow from small to big, from few to many principles, and observes the curative effect and the side effect. (3) must the time fixed time apply drugs according to medicine Guan Shuai, must before recently the drug efficacy vanished 1h to apply drugs, exempts increases the pain to the patient, increases the medicine dosage. 2nd, to the patient explained that accepts the treatment the effect, helps the patient to understand the ache produces the reason, takes why the medicine and the taking medicine time does tell the patient to take the medicine as well as the medicine on time has the side effect which and the prevention the possibility produces. 3rd, helps the patient to apply drugs correctly, according to patient's situation, chooses the appropriate medicine and the medication method. When medication, should consider the drug efficacy the duration and patient's habits and customs, avoid as far as possible when the patient rest applies drugs. 4th, the appraisal method of treatment to reduces the ache the effect, reported promptly to doctor, proposed the reasonable suggestion, causes to adjust the therapeutic schedule promptly. 5th, side effect prevention. If the aspirin can stimulate the stomach, the destruction gastric mucosa barrier causes the hemorrhage, and causes the zymoplasm original reduction to cause the whole body hemorrhage tendency and so on. 6th, in the full attention cancerous ache nursing process's integrity stops pain not only includes gives the pharmacological treatment, moreover, must give the patient to create a comfortable environment, helps the patient to obtain a comfortable body posture and so on. Follows frightened which and the anxiety cancer ache comes, the family member needs the related technology, the psychology knowledge helps the patient to overcome these barriers. In brief, the family member facing cancer ache's patient, do not increase the pain to them, or lets them struggle in the pain, but must the corrective method, reduce patient's pain unceasingly. At the same time, but must to doctor, nurse seek for advice unceasingly, seeks for advice to the books, for the patient relieve pain, coordinates doctor, nurse to complete cancer patient's treatment and the nursing survival percentage as far as possible.
In the cancer patient's subjective symptom, the ache formation rate is highest. The patient's condition patient has 40% to be accompanied by the ache at least. The terminal cancer patient 80% have at least moderate to the specific weight ache. According to the statistical data indicated: Because the world year has 2,500,000 people cancer ache not to be able to obtain the prompt treatment to die. In the world has 3,500,000 people every day, in cancer ache suffers gets by difficultly. The ache not only does not favor the ache the treatment. Also increased the pain to the patient. Reduced patient's survival quality obviously. First, in idea renewal The medical personnel, the patient, the public, the family member to ache understanding, manner, expectation as well as to ache treatment, nursing have had the huge change in the past's more than 30 years. Now, cancer patient's ache question obtained the entire community public figures to take seriously. Takes each kind of remedial measure decisively to cancer ache patient, high method relieves patient's pain, improved patient's survival quality, the extension life new idea has substituted for in cancer ache treatment traditional ideas gradually. But, are many expert to believe at present, the hindrance stops pain effectively the subject matter is not only nurse lacks the understanding to the anaesthetic pharmacological action, moreover, knows the insufficiency to person's life quality and the nursing job category itself. Doctor and nurse worried generally the patient uses the anaesthetic to be able to reappear the spiritual dependence, and the family member also harbors the dread including the patient himself to the anaesthetic. Presents “four does not hope the syndrome”, namely doctor is not willing the sufficiency the pain-killer, the pharmacy not to be willing to send the sufficiency the medicine, nurse/the family member is not willing to give the sufficiency the medicine, the patient is not willing to accept the sufficiency the pain-killer. Therefore not only needs the medical personnel regarding cancer ache's treatment to know that on the renewal, needs the patient and family member's coordination, particularly patient family member's cooperation. Second, family member's function Undeniably, cancer patient many are stays in hospital the treatment in the hospital, but, also had quite a partial cancer patient to pass after all in the home. Therefore, in cancer ache's treatment, the family member is also undertaking the very important responsibility. And includes: 1st, estimates reliably correctly patient's ache, assists the medical personnel to work out the reasonable therapeutic schedule. The patient ache estimates its content including the ache degree, the spot, the nature, the outbreak situation and the complication and so on. Family member when estimate patient's ache, must pay attention to the psychology, the society and the economy besides the bodily factor and so on various factors influence. 2nd, accurate, gives the phial bottle observation pain-relieving medicine promptly the effect and the side effect. 3rd, comforts for the patient, explains and encourages, to enable it to get rid from the spirit to the ache the fear, increases to the life the hope. 4th, the education and the explanation change for the patient to the medicine side effect and the tolerant wrong understanding, encourages the patient to enjoy person's dignity and person's authority. Third, family member's duty In the cancerous ache treatment's process, the role which its family member plays is unwise to underestimate, they need to complete the massive nursing work. Therefore, they must understand and grasp nursing the scope. 1st, understanding cancerous ache treatment basic principle: (1) grasps some effective, the main control ache medicine dosage and the applicable scope truly. (2) the pain-killer heart possibly takes orally, next, is the rectum medication, finally only then chooses the injection. The medicine use should follow from small to big, from few to many principles, and observes the curative effect and the side effect. (3) must the time fixed time apply drugs according to medicine Guan Shuai, must before recently the drug efficacy vanished 1h to apply drugs, exempts increases the pain to the patient, increases the medicine dosage. 2nd, to the patient explained that accepts the treatment the effect, helps the patient to understand the ache produces the reason, takes why the medicine and the taking medicine time does tell the patient to take the medicine as well as the medicine on time has the side effect which and the prevention the possibility produces. 3rd, helps the patient to apply drugs correctly, according to patient's situation, chooses the appropriate medicine and the medication method. When medication, should consider the drug efficacy the duration and patient's habits and customs, avoid as far as possible when the patient rest applies drugs. 4th, the appraisal method of treatment to reduces the ache the effect, reported promptly to doctor, proposed the reasonable suggestion, causes to adjust the therapeutic schedule promptly. 5th, side effect prevention. If the aspirin can stimulate the stomach, the destruction gastric mucosa barrier causes the hemorrhage, and causes the zymoplasm original reduction to cause the whole body hemorrhage tendency and so on. 6th, in the full attention cancerous ache nursing process's integrity stops pain not only includes gives the pharmacological treatment, moreover, must give the patient to create a comfortable environment, helps the patient to obtain a comfortable body posture and so on. Follows frightened which and the anxiety cancer ache comes, the family member needs the related technology, the psychology knowledge helps the patient to overcome these barriers. In brief, the family member facing cancer ache's patient, do not increase the pain to them, or lets them struggle in the pain, but must the corrective method, reduce patient's pain unceasingly. At the same time, but must to doctor, nurse seek for advice unceasingly, seeks for advice to the books, for the patient relieve pain, coordinates doctor, nurse to complete cancer patient's treatment and the nursing survival percentage as far as possible.
Regarding the terminal cancer patient, the ache is the most universal symptom. In view of the later period cancer pain, the World Health Organization (WHO) has formulated “three steps and ladders pain-relievings” in 1986 the principle of reatment, the People's Republic of China Medical department officially has also promulgated "Cancer Patient Three Steps and ladders Pain-relieving Therapy Guiding principle" in 1993, medical arena experts for many years has also been exploring eliminates the cancer pain the efficacious device. However, besides light moderate ache effect still permissible, the specific weight ache still lacked the effective means. In recent years, domestic and foreign has used one new analgesia method in the ache treatment aspect, namely the patient automatic control analgesia technique (patientcontrolledanalgesia, is called PCA). After at first mainly uses in the surgery stops pain, already widely applied in the later period cancer pain and in other stubborn ache treatment. Because many people do not understand or simply did not know that has this therapy, enables this new technology the very good service in the later period cancer painful patient. What is PCA? PCA is asks about somebody's well being handtailor Chu Yaobeng through a narrow tube places on the patient body, stops pain the medicine to enter after the PCA pump by the specific speed the medicine pump the human body to play continually the analgetic role, different may choose the different pump according to the ache degree to enter the speed. Pump's above also some automatic control button, when the patient felt when ache may hold back increases the replenishment dose. How to place? The PCA pump divides two kinds: One kind is the microcomputer control pump (also said that electronic pump), the automated control degree is high, the speed may adjust willfully, easy to operate, but the price is expensive, suits in hospital period use; Another kind is the disposable PCA pump, pours the medicine speed to be relatively fixed, the price is low, suits uses in the home. According to the ache spot, the scope and the degree are different, the medicine pours into human body's way to be possible to divide into three kinds: Hard membrane pericoel, vein and hypodermic. Generally speaking, below the chest, the ache spot and the scope relatively fixed patient, suit after the hard membrane pericoel (PCEA) the note medicine; Ache scope Guang Huoying the membrane pericoel puncture difficulty, suits after the vein (PCIA) or hypodermic (PCSA) the note medicine. Pump's size similar teacup, above has hangs the buckle, may hang in the waist, may install in the pocket, evening sleeps may place nearby the pillow. It is not hospitalized the patient may after the hospital imposition brings to go home, fixed time adds the medicine to the pump in then, is unable the hospital serious illness person also to be possible to ask ache branch doctor to treat illness in others to place. With what medicine? Generally has three kind of medicines: First, anaesthetic, like morphine, demerol hydrochloride, Fentaini and so on; Second, the local anesthesia medicine, mainly uses the cloth compared to Kain; Third, the stable calm medicine, the commonly used imidazole stable or the fluorine pai advantage are many. Merit: 1. gives the medicine automatically, but cannot be hospitalized, can participate in the general daily activity. 2. the analgetic effect is accurate, the patient may change itself according to the ache degree to supplement the medication. 3. the complication are few, is not easy to become addicted to, to the sleep, the diet and patient's spiritual influence is small. 4. the duration was long, reduced inconvenient which injected repeatedly brings. 5. uses the dose to be few, generally speaking the expense is low. The common side effect includes:①The disgusting vomit, initially uses common, reduces gradually.②The skin pruritus, take the face and the chest and back as heavy, the available antihistamine or the sedative.③The urine zhu remains, may give the ventral massage or the hot compress, when the necessity may the temporary catheterization. 4 breath suppress, generally is not obvious, is serious when gives the oxygen uptake.⑤Other, occasionally see the constipation, dizziness, to be addicted to rest and so on. Are different according to pump's quality and the performance and are different, generally speaking includes the pump and the technical cost approximately between 600~800 Yuan. a 3~7 day of Canadian medicine, the peaceful pump may use for 1~3 months. Generally the municipal above big hospital can make this kind of treatment, should look for ache branch doctor or anesthesiology department doctor receives a medical examination.
According to statistics: The nation cancer new diseased population approximately has every year 1,800,000, 62% are accompanied by the ache. Cancer ache is not only a medicine question, it is a social question. The World Health Organization once in 1982 proposed “in 2000 realized the world non-cancer pain” the specific objectives, we realized this goal possibility in 2000 to have in a big way? The traditional ideas must transform, otherwise the tumor stops pain is very difficult to complete. Certainly this need we the medicine specialists educate the patient, also needs your media the help, disseminates the entire society the correct idea. Some people believed frequently, once cancer patient with the analgetic medicine, means that has sounded the unlucky ding, this idea harm is big. In the real life, many people thought that so long as cancer patient used the analgetic medicine, particularly used the codein, the morphine and so on strong effect analgesic, explained already entered cancer “finally the last stage”. This is one kind of misunderstanding completely. Because receives this kind of misunderstanding the influence, many cancer patients fear so-called “the last stage to approach finally”, then suppresses the ache to suffer, refuses to use the pain-killer; Because or the ache is hard to endure, the patient starts to use the pain-killer, but thought that “the last stage approaches finally”, thus lost continued to treat and the survival confidence. The ache is a cancer patient's common symptom, the ache order of severity and whether to use the strong effect analgesic, with clinical time don't not too big relations. Cancer ache is in the cancer morbidity process ordinary phenomenon, may occur in any time leaves. Although the terminal cancer patient has the ache the proportion to be relatively high, but the early cancer patient may also have cancer ache, even possibly has the fierce ache. Whether cancer patient does have the ache and the pathological change infringement spot concerns. Because for example, a cancer patient the tumor grows in the nerve rich organization, although belongs to the early time, actually possibly has the fierce ache; Another belongs to finally the last stage cancer patient truly, because the pathological change has not implicated the nerve rich organization, possibly does not have the ache symptom. The ache will cause the serious harm, various issue of cancer patients should accept the analgetic treatment. Each clinical time other cancer patients possibly have the ache, but the ache creates to them the harm is similar. Cancer ache not only makes the patient to feel uncomfortable, will also bring a series of serious influences. For example, the disgusting vomit, the anorexia, losing sleep, anxious, frightened, despondent, are not willing with the human to associate; Each physiological function drops, energy drops; Lose the confidence to the life and the treatment and so on. Ache harm which to the body, the physiology and the psychological aspect creates, not only affects obviously patient's quality of life, will also affect the treatment implementation and the effect. Because the partial patients the ache have not been under satisfaction control to lose the patience, will give up permanently curing cancer's opportunity. Regarding various issue of cancer patient's ache should the active treatment, stop pain the treatment to eliminate reduces patient's pain, but is also helpful to the enhancement quality of life, is helpful in anticancer treatment treatment smooth completion. The anticancer treatment treatment itself can control the ache, but the analgetic appearance requires certain time. Therefore, before radical cure anticancer treatment treatment appearance, also has the necessity to carry on the analgetic treatment positively, so that the anticancer treatment treatment can complete smoothly. In addition, regarding already the patient who loses the radical cure anticancer treatment treatment opportunity, stops pain possibly is the partial patients only may accept with the effective method of treatment, because the analgetic treatment possibly causes the tumor patient under the indolence condition the long-term belt cancer survival, strives for to treat the time and the opportunity.
Regarding the terminal cancer patient, the ache is the most universal symptom. In view of the later period cancer pain, the World Health Organization (WHO) has formulated “three steps and ladders pain-relievings” in 1986 the principle of reatment, the People's Republic of China Medical department officially has also promulgated "Cancer Patient Three Steps and ladders Pain-relieving Therapy Guiding principle" in 1993, medical arena experts for many years has also been exploring eliminates the cancer pain the efficacious device. However, besides light moderate ache effect still permissible, the specific weight ache still lacked the effective means. In recent years, domestic and foreign has used one new analgesia method in the ache treatment aspect, namely the patient automatic control analgesia technique (patientcontrolledanalgesia, is called PCA). After at first mainly uses in the surgery stops pain, already widely applied in the later period cancer pain and in other stubborn ache treatment. Because many people do not understand or simply did not know that has this therapy, enables this new technology the very good service in the later period cancer painful patient. What is PCA? PCA is asks about somebody's well being handtailor Chu Yaobeng through a narrow tube places on the patient body, stops pain the medicine to enter after the PCA pump by the specific speed the medicine pump the human body to play continually the analgetic role, different may choose the different pump according to the ache degree to enter the speed. Pump's above also some automatic control button, when the patient felt when ache may hold back increases the replenishment dose. How to place? The PCA pump divides two kinds: One kind is the microcomputer control pump (also said that electronic pump), the automated control degree is high, the speed may adjust willfully, easy to operate, but the price is expensive, suits in hospital period use; Another kind is the disposable PCA pump, pours the medicine speed to be relatively fixed, the price is low, suits uses in the home. According to the ache spot, the scope and the degree are different, the medicine pours into human body's way to be possible to divide into three kinds: Hard membrane pericoel, vein and hypodermic. Generally speaking, below the chest, the ache spot and the scope relatively fixed patient, suit after the hard membrane pericoel (PCEA) the note medicine; Ache scope Guang Huoying the membrane pericoel puncture difficulty, suits after the vein (PCIA) or hypodermic (PCSA) the note medicine. Pump's size similar teacup, above has hangs the buckle, may hang in the waist, may install in the pocket, evening sleeps may place nearby the pillow. It is not hospitalized the patient may after the hospital imposition brings to go home, fixed time adds the medicine to the pump in then, is unable the hospital serious illness person also to be possible to ask ache branch doctor to treat illness in others to place. With what medicine? Generally has three kind of medicines: First, anaesthetic, like morphine, demerol hydrochloride, Fentaini and so on; Second, the local anesthesia medicine, mainly uses the cloth compared to Kain; Third, the stable calm medicine, the commonly used imidazole stable or the fluorine pai advantage are many. Merit: 1. gives the medicine automatically, but cannot be hospitalized, can participate in the general daily activity. 2. the analgetic effect is accurate, the patient may change itself according to the ache degree to supplement the medication. 3. the complication are few, is not easy to become addicted to, to the sleep, the diet and patient's spiritual influence is small. 4. the duration was long, reduced inconvenient which injected repeatedly brings. 5. uses the dose to be few, generally speaking the expense is low. The common side effect includes:①The disgusting vomit, initially uses common, reduces gradually.②The skin pruritus, take the face and the chest and back as heavy, the available antihistamine or the sedative.③The urine zhu remains, may give the ventral massage or the hot compress, when the necessity may the temporary catheterization. 4 breath suppress, generally is not obvious, is serious when gives the oxygen uptake.⑤Other, occasionally see the constipation, dizziness, to be addicted to rest and so on. Are different according to pump's quality and the performance and are different, generally speaking includes the pump and the technical cost approximately between 600~800 Yuan. a 3~7 day of Canadian medicine, the peaceful pump may use for 1~3 months. Generally the municipal above big hospital can make this kind of treatment, should look for ache branch doctor or anesthesiology department doctor receives a medical examination.
The appraisal ache's best method is to the ache essence trust, the use reliable effective tool and understood that some related aches the question, may understand the ache well the essence. 1.1 influence correct appraisal factor 1.2 patient's ages, sex, disposition and cultural context: Generally speaking, the senior compares the youngling to endure the ache, the disposition introvert are few to the ache principal claim, the same level degree's ache responds in the disposition extravert can be intense, the principal claim are more. National, the family, past experience will have the influence to the ache appraisal. 1.3 nurses factor: In many hospitals, has not become the nursing work convention to the ache appraisal, only in the patient proposed when ache or request analgesia only then passively processes. Lacks the correct measurement ache the tool to cause the patient principal claim and nurse appraises accounts for 77% not identically, nurse has appraised patient's ache to account for 54% lowly, nurse the high appraisal ache has only accounted for 13%. Appraisal method 2.1 0-10 level of linear visual simulation grading law: In rod's both sides, the sign has from 0-10 digit, the digit is bigger, the expression ache intensity is bigger. When use, to the patient explained first 0 represent the indolence, 1 represents the slightest ache, 10 represent the most serious ache, which position finally understands the patient this time the ache in rod's. Appraisal standard: Slight ache 1~4 levels (for example ill, heavy item oppression feeling, passive ache, inflammatory pain); The moderate ache 5 ~6 levels (for example jump pain and convulsion, burning sensation, extrusion feeling and stabbing pain, touch a sore spot with tenderness); Serious ache 7~9 levels (for example hindrance normal activities); Fierce ache (beyond control). This Nurse Hori Yu grasps the ache accurately the degree, favors the appraisal control ache the effect. 2.2 Wong-Banker facial expression meter law appraisal ache: This method from the smile expresses the ache degree with 6 kind of facial expressions to the sadness to the sob. This law suits any age, does not have the specific cultural context or the sex request, easy to grasp, does not need any additional equipment. The acute ache, old person, the young child, power of expression forfeit is specially suitable. 2.3 Memillan ache estimate table: The ache degree indicated with the range estimate direct-viewing ache rod that and draws the ache spot (patient or nurse picture). Nurse asks the following question and the record to the patient: How does your ache start? When starts, what kind of stimulation can cause the ache? Your ache has the long time? Endurance or discontinuity? Please describe the ache situation and the change situation. Describes your ache with yours language. How can alleviate the ache? How can aggravate the ache? How can stop pain? How to do cannot stop pain? When ache outbreak has what symptom? Ache at which aspect like sleep, appetite, body, attention, mood, social activity and so on to you to be whether influential? You thought that is what reason causes your present's ache? This law can make the comprehensive appraisal to the ache and the correlation factor, is suitable in whole nursing the appraisal ache. 2.4 use to describe the ache degree the glossary: Melzeak with mild, specific weight ache, labor pain, the fearful ache and is unable the ache which endures and so on to help the patient to describe own ache, causes the patient to express well the ache. This method meets patient's psychological need, but is affected in a big way the subjective factor. 2.5 monitor patient's change: Monitors the patient life symptom, the breath way, the partial muscle's tensity, the palm perspiration and so on indirect understanding ache degree.
Cancer's three steps and ladders pain-relieving law, is one kind according to patient's ache degree is different, but uses the different rank to stop pain separately the medicine for the principle of reatment analgetic method. As one kind most commonly used, and the extremely effective analgetic method, recommends vigorously for World Health Organization (WHO), widely has been applied in treats each kind of constant pain. Uses three steps and ladders pain-relievings method premise is must learn the cancer painful rank appraisal. Must divide into patient's cancer pain light, medium and heavy third-level, the most commonly used method is uses 0~10 levels of aches to appraise the meter. Doctor inquires to the patient asks him to reply: “if 0 are the indolences, 10 can imagine painful for you, then how many levels your present's ache is? The ache is heaviest when is how many levels? Lightest when is several levels?” although 1~4 levels are the mild ache, the patient have the pain but to be possible to endure, can the normal life; 5~6 levels are the moderate ache, the patient ache are obvious, cannot endure, affects the sleep; 7~10 levels are the specific weight ache, the ache are fierce, cannot go to sleep, may be accompanied by the passive body posture or the nervus autonomici function disorder performance. After having clarified patient's ache rank, then defers to the cancer pain treatment 5 main principles which WHO proposed to give the medicine: First, the oral administration gives the medicine. Simple, not creates, is advantageous for the patient long-term medication, is suitable to the majority ache patients. Second, gives the medicine on time. Attention: Is gives the medicine “on time”, but is not time the ache only then gives the medicine. Third, gives the medicine according to three steps and ladders principles. According to the patient ache's light, medium and heavy varying degree, gives the different steps and ladders the medicine. Below we enumerate in various steps and ladders separately the commonly used medicine. The first steps and ladders mild ache gives the non-meconium class (non-steroid class anti-inflammatory agent) to add and subtract the auxiliary pain-killer. Attention: Non-steroid class pain-killer existence most greatly effective dose (ceiling effect note) question. The commonly used medicines including the paracetamol, the aspirin, the double chlorine fragrance sour salt, Canada gather hundred clothing Ningxia, the cloth Luo river fragrance, the fragrance to (cloth Luo river fragrance slow release capsule), indomethacin, yin duo US Xin, Italy Shi Ding (yin duo US Xin Kongshi the piece) and so on. The second steps and ladders moderate ache gives the weak meconium class to add and subtract the non-steroid class anti-inflammatory agent and the auxiliary pain-killer. The weak meconium class medicine also has the ceiling effect. Because the commonly used medicines have the codein, the strong pain to decide, Qu Maduo, wonderful graceful Ding (Qu Maduo to release slowly piece), a pair of gram (codein to control release piece) and so on. The third steps and ladders specific weight ache gives the meconium class to add and subtract the non-steroid class anti-inflammatory agent and the auxiliary pain-killer. Strong meconium class medicine non-ceiling effect, but may produce endures, must suitably the incremental dose to overcome endures the phenomenon. Formerly thought that stops pain with the morphine can become addicted to, therefore is not willing to the patient to use the morphine, now proved that this viewpoint is the wrong - - - use morphine cancer painful patient extremely little has the addictive nature. This steps and ladders commonly used medicines have the morphine piece, US and Philippines Kang (morphine slow release piece), US to execute Kangting (morphine to control release piece, but rectum gives medicine) and so on. But, demerol hydrochloride this formerly commonly used pain-killer, because its metabolite toxicity big and so on factors, has not been recommended uses in controlling the constant pain. Moreover, some auxiliary medicine's use increased the analgetic curative effect, reduced the pain-killer dosage, had the good analgetic effect. These medicines including the cerebral cortex steroid hormone dexamethasone and the strong pine, may reduce the ache which peripheral nerve dropsy and the oppression cause; Anti-despondent medicine Arab League Mi Tilin, considers thoroughly evenly, US Shu Yu, hundred sorrow solution, uses for to ease the pain, calmly, the improvement mood; Anticonvulsant card horse Siping, the benzene proper UK sodium, after may treat tearing and the cauterization type pain and put the chemotherapy, the ache; The tran-Q class antihistamine, uses in easing the pain, calmly, the town to spit. Fourth, medication individuation. The medication dosage needs to determine according to the patient individual situation that take the indolence as the goal, does not deal with the dose to limit strictly has caused the medication insufficiency. Fifth, observes the patient applies drugs the change after strictly, the stitch in time each kind of medicine's side effect, the observation evaluation medicine curative effect, adjusts the medicine dosage promptly. In addition, but must pay attention to between the medicine the interaction as well as the medicine stops pain questions and so on complex therapy which unifies with other methods. Recently, the national Drugs Surveillance Administrative bureau cancelled cancer patient to use the morphine the maximum dose limit, this has manifested the Government department regarding the promoted cancer pain three steps and ladders treatment determination, also manifested Our country Government with to appease the treatment work to the cancer pain control the support. As for the medical personnel, changes the old idea, studies the essential analgetic medication knowledge is the urgent matter.
1 influence cancer pain control factor 1.1 feared that the anaesthetic becomes addicted to: In most situations, nurse only when patient principal claim ache only then gives the spare pain-killer, but patient because also feared that becomes addicted to endures suffering, is only when the ache is unable endures only then to request the pain-relieving. The massive research indicated that no matter the anaesthetic dosage is much big, in uses in the patient who the anaesthetic stops pain, becomes addicted to the occurrence is only 1%, after most patient ache control, namely stops the medicine, even if appears becomes addicted to is also may treat. In the terminal cancer patient, the pain-relieving is the first place. 1.2 medical systems to control the ache the restriction and the limit: ①In the hospital restricts the implementation analgesia the factor: The processing deficient sense of responsibility and protects the trouble relations complex with the medical personnel to the ache related, cannot the active control mainly attribute to the ache does not have the specialists to be responsible. Staff nurse below strength, the work load are big, cause the patient not to be willing excessively many to be troublesome nurse are also cause the patient to obtain the active control ache the barrier. ②Sends the medicine system's restriction and the restraint: The hospital stipulated that the control poisonous anesthetic must have 2 above nurses to inspect, as if the ache when sends the medicine was confirmed that if carries on the long-enduring appraisal to each patient's ache, changes when the ache gives the medicine for the medicine before the ache, receives this kind of medical system's restriction inevitably, although appeared had more and more pain-killers to discover, but the patient was still enduring the ache the phenomenon. 2 analgetic measures 2.1 WHO recommendation cancer eases the pain three steps and ladders pain-relieving law: The first-order ladder starts from the non-meconium class analgesic, like the aspirin, the strong pain decide, the even pain to be new, indomethacin and so on; If cannot alleviate, based on this adds with the weak meconium class analgesic, like codein, hydroxy dihydrocodeinone, third oxygen phenol and so on; If the ache is fierce, then may use the strong meconium class analgesic for example: Du, the morphine, the hydroxy hydrogen morphine alkone, the morphine hydrochloride, hydrochloric acid dihydro Egypt holds the Philippines, US Shi Kang Ding suddenly and so on. 2.2 Chinese medicine treatments: ①Traditional Chinese medicine pain-relieving liniment: Base we medicinal preparation composition: The yanhusuo, the salvia miltiorrhiza, the Taiwan lindera strychnifolia, the flea body, the ground beetle insect, the blood use up, the borneol. After the confirmation, the alleviation rate is 79.2%, decides closely with the strong pain, alleviation time strong pain fixed-length. Merit: The traditional Chinese medicine after the skin absorption, does not have the wound, and the display drug efficacy quick (general 10min may pain-relieving), the operation is simple, is safe, the poisonous side effect is small, the non-medicine dependence phenomenon, is good to the mild ache effect. ②Shui Zhen treats: This law plants and the ache spot different selection different acupuncture point according to sickness, decides, the dexamethasone, the Vitamin B12 acupuncture point injection by the skull pain, with in the Chinese medicine tradition's acupuncture, plays the analgesia role through the channels and collaterals, also unified the modern medicine characteristic, with the medicine adjustment internal secretion, has the accurate analgetic effect to reach 100% to the mid and late stage cancer painful effectiveness. 2.3 low concentration morphine hard membrane extrapolation note: This law basis ache in the spot, selects the corresponding nerve stage, 0.02% morphine hydrochloride dilute by physiological saline 10ml, pours into the hard membrane pericoel, after pouring the medicine, the 2~10min aware ache has the varying degree to alleviate, the mood improvement, the most patients can go to sleep peacefully at night, the alleviation time reaches 12h, generally gives the medicine one time then to satisfy the patient every day to request. If will inject the end seal in the aseptic bottle, will set at the tube spot by the sterilized dressing wrap, may inject repeatedly. This law especially qualify household sickbed patient, sets at the tube to retain 20d generally, longest reaches 37d. 2.4 psychological nursing and mental healing: ①Relaxation and image intervention: The relaxation refers to applies some kind of bodily activity like rhythmicity breath or in a disorderly way causes the muscular tone and the relaxation according to the order, achieves reduces or the reduced environment stimulation, the muscular tone, the mood is anxious and goal of the ache feeling. The so-called image is refers to the utilization to have the goal thought activity, the tentative plan can serve some kind of treatment purpose, reduces the ache. This law can reduce the ache, does not have the influence to the patient function condition. But lacks the explicit target and the procedure, waits for further discussing. ②Mental healing: The object should choose the cultural level high, young, to have the study to accept ability, the treatment desire to be urgent, and not obvious character disorder. First should educate the patient, causes its change to the medicine side effect and the tolerant understanding; Through releases sparsely again and comforts, namely nurse when the patience listens to the patient condition and the mood feeling, expresses the sympathy fully, gives the suitable comfort. Based on this, the use suggested that mental healing's and so on flaccid therapy special methods, have certain function to the pain-relieving. Moreover, lightens the patient psychological burden, enhances the threshold of feeling, maintains the environment peaceful comfortable, carries out the protection medical system and strives for the family member coordination and so on, in cancer ache patient's psychological nursing is also essential. And consummates along with the whole nursing gradual implementation, nurse is playing more and more vital role in cancer ache's control. Masters the correct appraisal method, implements the effective analgetic measure and consummation nursing, to improves cancer ache patient quality of life, realizes in 2000 which WHO proposed cancer ache patient no longer ache's goal to have the vital significance.
Cancer pain-relieving medicine main minute three broad headings: Non-meconium class, meconium class and auxiliary medication. (1) non-meconium class:①Non-steroid body class anti-inflammatory agent: Including big catkin willow acids medicine (aspirin) and non-big catkin willow acids medicine (cloth Luo river fragrance);②Paracetamol. (2) meconium class:①Weak meconium class: Take the codein as representative, but also has the dextrorotary third oxygen phenol and the hydroxy tests the alkone;②Strong meconium class: Take the morphine as representative, commonly used has the oral administration morphine ordinary piece and controls releases the piece, as well as Ding Bingnuo Philippines, Fentaini, symoron, demerol hydrochloride and so on. (3) auxiliary medicine:①Anticonvulsant: Tegretal, third propyl-acetic acid and so on;②Anti-despondent medicine: Arab League Mi Tilin, imipramine and so on;③Antianxietic: Benzene two nitrogen mixed Zhuo Lei, stable, phenol thiazide and so on;④Cerebral cortex steroid class.
Gives the analgetic medicine on time to the cancer patient, is must defer to the medicine the response time, stipulated the time-gap gives the medicine, but is not only in the patient ache time only then gives the analgetic medicine. The reason is as follows: 1st, after first for medicine, requires certain time to be able to achieve the effective blood medicine density, particularly controls releases (slow release) the medicine, if the morphine sulphate controls releases the piece to be able to achieve the effective blood medicine density for the medicine latter 1 hour. In this “blank time”, if for the fast-acting medicine, the patient still do not endure the ache. 2nd, the ache often is accompanied by the mood, the psychological change, after the ache appears, only then gives the pain-killer, often needs to give compared to a maintenance pain greater dose cannot achieve analgetic the goal. 3rd, when patient ache only then the line stops pain, often needs to give the fast-acting analgetic medicine, but so gives the meconium class medicine often to cause the blood medicine density intense large fluctuation, increases the untoward effect. Therefore, should choose the persistent effect to control as far as possible releases the dosage-form like morphine sulphate to control releases the piece (US to execute Kangting) and so on, gives the medicine on time, but is not on demand gives the medicine, like this can guarantee that maintenance effective, steady blood medicine density, guaranteed that the ache alleviates continually, and is not easy to have the energetic dependence.
Cancer ache is a universal worldwide basis question, according to the World Health Organization (WHO) the statistics, 30%-50% cancer patients is accompanied by the varying degree the ache, because the entire society, even the medical personnel to this question understanding insufficiency, the cause around the world have 3,000,000 - 5,000,000 cancer patient long time to suffer the ache to suffer cannot obtain the effective treatment. In order to improve cancer patient's quality of life, WHO established the cancer pain in 1982 in Italy to treat the Expert board, after the discussion thought that the application existing and might relieve the majority cancer patient's ache for the number limited analgesia medicine, and proposed that “achieved to 2000 in the world scope causes cancer patient was not painful” goal [1]. Our country Medical department responded positively this summons and has taken a series of measures, like conducted the nationwide study group, the seminar; Provide guidance document and study material [1-3]; Adjustment narcotic supply policy; The organization develops develops some narcotic the new variety, if the morphine controls releases the piece. In order to enable the Foshan area to achieve WHO to set “the goal”, it is necessary to make an investigation to the Foshan area cancer pain medication present situation, in order to take further measure for the Department responsible for the work to provide the objective beneficial data information. 1 material and method Uses 1993-1995 year all previous years consumption stupefactive analgesic variety which, specification and schedule of quantities and about study and implementation independently designs “guiding principle” situation 10 question questionnaires, issues separately by the sanitation bureau medicine policy branch the Foshan area (including Foshan, the South China Sea, Shunde, three water, wise five cities) various hospitals medicament branch and the related medical personnel fills. The issue time was in February, 1996, received the table time is in April, 1996. 2 results 2.1 take back 76 hospital medicament branch the statistical data, but can list separately according to the request the tumor branch medication has 37 hospitals. Has counted these 37 hospital tumor branch 1993-1995 year all previous years use stupefactive analgesic variety and the total quantity, discovered that the injection pai for ding is the application most main analgesic, next has the morphine injection, the codein tablet, the dihydro etorphine tablet, in 1995 also used the morphine to control releases the piece and Ding Bingnuo fei. Looking from the 3a medication total quantity, seemed to be increases year by year tendency, but is not too remarkable. 2.2 approach Foshan area 28 hospital related administrative offices provide questionnaire 210, reclamation answer paper 208, the effective volume is 206. because 3 discussions medical department, in implemented WHO to set “the goal” to take a series of effective measures, this city medicine policy department has also carried on the corresponding work, thus the majority of medical personnel (64.1%) have studied earnestly or have looked at “the guiding principle” generally; 94.7% people can apply drugs according to three steps and ladders for the cancer painful patient; 79.1% people thought that eases the pain thoroughly for the cancer painful patient has the necessity very much, because they saw personally some cancer painful patient is in deep sorrow, because some patients cannot obtain the enough medicine from the regular way, but purchases the heroin pain-relieving secretly. Thought that is not unnecessary is mainly worries the patient to become addicted to, either the patient could not withstand the medicine untoward effect or the worry drugs cannot guarantee the supply. The Foshan area most medical personnel's ideological concept had the preliminary transformation, but is also very insufficient. Looking from the narcotic 3a consumption, seemed to be advances year by year tendency, but the scope is not big. in 1995 had the hospital to use the new variety - morphine to control releases the piece. The existence question and suggested: (1) medical affairs, the medicament, the administrative personnel study “the guiding principle” not to be very also common and thorough, various aspects personnel have not reached the mutual recognition, if got the card patient to go to the pharmacy to take the medicine, the pharmacy did not coordinate, still according to old rule management. The suggestion further conducts has the study group which, the seminar various medical unit administrative personnel, the medical care personnel, the medicament personnel participate; (2) ideological concept thorough transformation, “has not become addicted to the phobophobia” still to fetter the general medical personnel's hands and feet. According to recently to dependent explanation [4], only then spiritual dependence, and has the compulsion to abuse is accompanied by endangers the society the doer only then to call becoming addicted. The becoming addicted to medication is for the pursue euphoria experience, but the cancer painful patient applies drugs the goal relieves the ache. Some investigation material indicated that in the long-term cancer pain treatment's patient, doubts has the becoming addicted to proportion not to 0.2%[5]. In our investigation material has 32% related medical personnel to see 1-6 examples because of the long-term use pai for the patient who ding becomes addicted to, but they refer to most is the tolerance which or the bodily dependence produces to the medicine, this is the normal Pharmacology which the application stupefactive analgesic appears inevitably continuously responded, so long as stops the medicine not suddenly, will not have the problem. Therefore we should “becomes addicted to from the fear” in the fetter liberate thoroughly, according to the clinical ache treatment's need, uses the stupefactive analgesic reasonably, moreover must strengthen the propaganda dynamics through each form, the transformation society public's idea; (3) investigation indicated that still injected to the specific weight ache pai for ding primarily, this and world developed country medication tendency exactly opposite [5]. pai for ding the major object is the response time short (2.5-3.5 h); Injection spot partial irritant; Its metabolite in vivo half-life is long, the redundant medication has to the central nervous system annoys the toxicity violently, may send the spirit exceptionally, to tremble and to faint from fright [6]; Adds again pai is obvious for ding the blood medicine density valley phenomenon, has the untoward effect reason. Therefore the WHO expert promotes with great effort use persistent effect oral administration preparation [4], recent years produced the morphine controlled releases the piece is the ideal variety, Greece organizes these drugs the supply; (4) suggestion "Narcotic Special-purpose Card" sends the card power to release from the sanitation bureau to the hospital medical affairs imposes the convenience cancer painful patient to receive; The suggestion changes a beforehand annual report narcotic plan one quarter to report one time, moreover does not remove temporary urgently needed; Also the suggestion in guaranteed that prevents the narcotic inflow society to become narcotic under the premise, simplifies the cancer painful patient to lead the medicine the procedure.
The cancer pain is the mid and late stage cancer patient universal existence question. At present according to the World Health Organization statistics, the cancer patient who the world occurs every year approximately has more than 700 ten thousand, 30%~50% are accompanied by the degree different ache. Our country recent investigation indicated that in the General hospital and in Specialized hospital's various issue of cancer patient, is accompanied by the varying degree ache to account for 51.1%. The ache is the cancer patient is most painful, endures most with difficulty one of symptoms, regardless of therefore doctor or the patients deal with it to have the clear understanding. Causes the cancer patient ache reason to be possible to divide into:①Ache which causes by cancer itself, if the tumor creates in partial either the shift spot infringement or the oppression nerve fiber ache, this is the most common reason.②Ache which causes by the treatment, after like surgery, scar constant pain, after chemotherapy stomatitis and so on.③Loses the ache which by the viability causes, like constipation, bedsore.④Ache which has nothing to do with cancer, like osteoarthritis, fascutis ache and so on. Because the ache is one kind of subjective sensation, thus the subjective factor (for example sensitivity, attention, mood, physical condition and so on) is affected in a big way. If the similar ache stimulation, is high in the sensitivity, the attention centralism, the fall in the blues and the bodily ordinary circumstances bad person causes the ache feeling is quite intense. You have possibly had such experience, when the centralism energy does an intense work either the activity (for example some kind of competition), the hand or the body are cut down the hemorrhage, but a feeling does not have, but others saw, tells you, only will then realize was injured. The cancerous ache's patient regular session related to doctor that the ache is evening heavier than the daytime. This is because the daytime will be engaged in each kind of activity, in addition the optical fiber, the sound stimulation, these can disperse the patient to the ache attention, but stopped the activity to the evening not having the light and the sound stimulation, the attention will also concentrate the ache spot, the ache will aggravate. Therefore has the cancerous ache patient, should understand fully these influencing factor, sets up defeats the indisposition the confidence, treats it by the strong will and the brave manner, and carries on some distractive the activity, like looked that the television, listens to the radio, to look the books and periodicals or recalled some meaningful matters, to a great extent will reduce the indisposition suffering.
(1) uses the pain-killer as far as possible early The control cancer pain's efficacious device is uses the analgetic medicine early, the prevention ache occurrence or prevents its aggravation. That is, if the ache appeared, do not wait till it becomes serious has treated again, but when just started, the use pain-relieving medicine control ache, like this obtains the effect is good, are also few with the dose. (2) not suitable pure dependent pain-killer The pure dependent pain-relieving medicine may not take. Because, each person is dissimilar to the pain-killer response. Not only this reflected that in the medicine variety, in the display drug efficacy's time, is the identical person uses the identical medicine, in the different time, the different environment produces the analgetic results to be also different. Must therefore pay attention to the flexibility in the pain-killer choice and the application method, and attempts to seek is suitable for own most effective analgetic method. While takes the analgetic medicine, may also apply the non-medicine pain-relieving method, like bodily relaxation therapy, distractive and so on. Not only this can enhance the analgetic effect, moreover causes the pain-killer to reduce with the dose, the working life lengthens, even cancels the medicine not to have the ache gradually.
The findings which according to the scientist at this week convenes the American Mind and body Association annual meeting which announces, in adult, if puts some sweet taste food on his/her tongue, can increase it to the ache tolerance. Studied for the doctorate in the McGill university Maxim D. Lewkowski to tell Reuter reporter saying:“the sweet taste liquid as if has the analgetic function.”Some research in before this once discovered that before gives an injection to the baby, gives them first oral administration sweet taste food, can reduce baby's making a tearful scene. Its reason possibly is causes the baby to ache better tolerance, but this kind of function in adult whether effective, are very actually few some people to study. In order to clarify this question, Lewkowski et al. investigated 72 young adults, lets them taste the sweet taste, the bitter taste solution or the clear water successively, then observes them to put in the hand the time length which in the ice water can endure. The result showed that when tastes the sweet taste liquid, it endures the time in the ice water to be longer, is 85 seconds equally, comparatively, when tastes the bitter taste liquid the mean time is 82 seconds, tastes when the clear water is 83 seconds. The researchers extrapolated that on tongue's sweet taste can promote the analgetic material function which to a certain extent in the human body produces naturally, these analgetic material is called the meconium class material or in fei the peptide. The researchers discovered that in blood pressure somewhat low trying, this kind of function is more remarkable. In a blood pressure somewhat low part trying, the sweet taste can make it to increase to the ache tolerance approximately 18%, but regarding these blood pressure high trying, the sweet taste does not have what function. Lewkowski said that this discovery showing or has hypertension regarding these hypertensions to favor trying, the sweet taste cannot play the alleviation ache the role. This possibly is because they produce naturally to the human body in the analgetic material reactivity reduces reason. The Lewkowski reminder said: “what is consistent with this extrapolation, hypertension's individual is bad to the analgetic material sensitivity.”
The clinical practice proved that prompt, uses the analgesic on time, not only may receive the good analgesic effect, moreover may choose the analgesia intensity low medicine, the use smallest dosage. When if the ache is fierce time uses the analgesic, the patient must suffer the ache suffering. If cannot obtain the analgesia treatment for a long time, because the cancer patient easy to have the ache to cause with the nerve pathological ache related nerve function disorder, displays for over sensitivity to pain and unusual ache and so on difficult the aches. Therefore, when not suitable the ache is fierce uses the analgesic. Can the part alleviation ache then On clinical, carries on the analgesia treatment to the cancer patient ache the goal eliminates the ache, improves cancer patient's quality of life. Let the cancer patient under not the painful condition the sleep, is eases the pain the treatment lowest standard to the cancer patient. The ideal analgesia treatment goal is lets the cancer patient rest, the activity under not the painful condition, the work. Cannot satisfy in the cancer patient ache part alleviates, must pursue the ache to eliminate completely. With pai for ding eases the pain is most effective, is safest Now did not advocate that pai for ding will use in cancer analgesia treatment, WHO pai for ding will not have listed as to cancer ache analgesia treatment medicine. The reason is:①pai for ding the analgesia function intensity is only the morphine 1/10~1/8.②pai for ding the analgesia duration is only the morphine 1/2~2/3.③pai for ding the metabolite to go to the armor pai for ding, to the central nervous system and the kidney virose function, its half-life is 3~18 hours. 4 pai are bad for ding the oral administration biology exploitability, must achieve the analgesic effect oral administration to the incremental dose, this time, goes to the armor pai for ding the quantity rises doubled and re-doubled.⑤Because pai is bad for ding the oral administration biology exploitability, uses the intramuscular injection to give the medicine, but the intramuscular injection itself will cause the ache. In brief, pai for ding is not suitable the patient who uses in the long-term ache. The meconium class medicine only suitably uses for the terminal cancer patient endures the quantity most greatly The clinical practice proved that the meconium class analgesic's amount used has the big individual difference, the minority cancer patient eases the pain the treatment to need the high dose. The pharmacology experiment prompts: The meconium class analgesic not places an upper limit on the effect. So long as the ache intensifies, may increase the meconium class medicine the amount used enhancement analgesia treatment effect. Regarding any specific weight ache patient, regardless of cancer clinical by stages sooner or later, estimate life length, so long as the analgesia treatment need, should use promptly endures the quantity meconium class analgesic most greatly, but cannot only to soon die the terminal cancer patient uses endures the quantity most greatly. The meconium class medicine presents the untoward effect to stop using The clinical practice proved that the meconium class medicine's untoward effect besides the constipation, majority is temporary, is also may endure. Therefore, as soon as sees the untoward effect to appear immediately stops the use meconium class medicine the method not being possible to take. Once the meconium class medicine uses is unable to stop using In medical practice, so long as the cancer patient ache cause of disease is under the control, the ache eliminates, momentarily may stop using the meconium class analgesic. When the morphine everyday use quantity is 30~60mg, will stop the medicine not to have the accident generally suddenly. The decrement will stop the medicine to the long-term massive medication's patient not to have the accident gradually. The decrement stops the medicine to make the law is specifically gradually: In initial two days decrement 25%~50%, every two day of decrements 25%, until the everyday use quantity are when thereafter 30~60mg stops the medicine. In the decrement process, whether there is should observe the cancer patient ache symptom gradually to appear. If has the ache symptom, and grades is bigger than 4, should further slow decrement, avoid stopping the medicine to have the ache symptom and the abstention too quickly breaks the symptom. The meconium class medicine cannot use in the lung cancer patient The practice proved that the meconium class medicine can use in the lung cancer patient ache effectively safely the treatment. Thought that the meconium class medicine cannot use in the lung cancer patient ache treatment the root lying in the meconium class contraceptive to have the side effect which the breath suppresses. In fact, lungs disease causes the scant of breath is circumference venereal diseases changes is the lungs pathological change result, but the meconium class medicine causes the breath suppresses is the side effect result which suppresses to the Respiratory center. The meconium class medicine itself does not aggravate the lungs pathological change. At the same time, the meconium class medicine the side effect which suppresses to the Respiratory center, generally only occurs when the medication excessive or the kidney function not all causes the medicine to store up. The meconium class medicine long-term use can have the energetic dependence In the clinical practice, the long-term use meconium class medicine, adopts the oral administration particularly or passes the skin way to give the medicine, the cancer patient presents the energetic dependence (formerly was called becomes addicted to) the risk extremely micro. Chinese Academy of Medical Sciences harmony Medical college Tumour hospital academician Sun Yan in the be more than 40 years cancer diagnoses in the process, only saw that 4 example patients have the energetic dependence. The average 10 years only then see one time. And, has carried out three steps and ladders pain-relieving therapy since 1990, an example had not seen. Overseas Porter reported that the use meconium class medicine presents the energetic dependent risk to be lower than extremely four (i.e. 4/11882). This explained sufficiently the cancer patient uses the meconium class medicine to cause the energetic dependence to be rare.
In fact all cancer sickness can experience the ache by no means that however has many different reasons to be possible to cause cancer sickness ache. The ache may be because of treats causes, for example patient after operation will experience the ache which the operation itself will cause. Even the ache also possibly has nothing to do with completely with cancer itself, for example the muscle sprains, the toothache, or the headache and so on. Cancer ache's degree and cancer's type, disease's stage as well as the patient himself concerns to the pain stickability. Continues several days or the long-time cancer ache, but because below reason occurrence: 1. tumor oppression nerve. 2. inflammation or inflammation response. 3. the blood vessel channel is blocked causes the blood circulation not to be good. 4. in the body some organ or the pipeline are blocked. 5. causes the bone fracture the cancer cell shift to the bone. 6. the operation following function, because of lacks the activity to cause stiffly, or medicine side effect, like constipation, oral cavity broken skin. 7. pair of disease's non-body responses, like anxious, depressed or anxious.
St. Louis, on April 2 (MD information) publishes in a March number ache medicine magazine research indicated that after the technique and the tumor ache processing plan's choice, clinician has the big difference. University of Michigan's Carmen R. Green and John R.C. Dr. Wheeler selects 368 clinicians stochastically, studies them after the acute technique ache and tumorous ache processing. After researchers 3 example acute techniques, the ache and 2 example tumorous ache patient's brief medical history notification clinician, requests them to give the corresponding processing measure. The result discovered that after more than 50% doctors conventional processing technique ache, but is short in 20% doctors processes the tumorous ache frequently. Generally speaking, surpasses 3/4 doctor to think that the treatment the goal does not cause complication at the same time to stop pain fully. The researchers pointed out that clinician to ache processing existence remarkable difference, with patient sex related, after 56% doctors will give the prostate gland excision method masculine patient's sufficient pain-relieving treatment, but 42% after the only breast excision method's feminine patient can obtain same processing. In the tumorous ache aspect, doctor uses the sufficient analgetic treatment to the male and the feminine patient the proportion to be very low, the transferability prostate gland cancer and breast cancer's treatment rate respectively is 16% and 11%. Green and Dr. Wheeler believed that at present has the essential research clinician's in ache treatment practice difference, after must improve the technique, the ache and the tumor ache's analgetic treatment, “doctor the difference” is a consideration factor.
The ache is the cancer most common symptom, but the cancerous ache is the patient and the family member most headache question. A some patient ache uses the painful piece and the Du cold fourth place medicine on the request, have never realized premature excessive easy to become addicted to and to have the drug resistance with this kind of medicine, therefore, plants regarding sickness is long and the ache light cancer patient, should use the psychotherapy and the physiotherapy stops pain, as soon as might as well tries. The psychological suggestion pain-relieving law is mainly strengthens patient oneself to defeat disease's confidence. May unify each cancer method of treatment, suggested how the patient does carry on own adjustment, tells him, if the coordinate treatment certainly can defeat disease, completes the eat three meals a day earnestly and carries on the essential recovery training, transfers oneself by this to annihilate the cancer cell most greatly fully ability, serves the analgetic purpose. The shift pain-relieving law may be called the patient to sit on a comfortable chair, closes both eyes to think the first childhood interesting may the happy matter, or thought are willing to think any matter, each time 20 minutes; May also like according to the patient, electing to put some lively high-sounding talk music, lets the patient on the one hand appreciate on the other hand does along with the rhythm hits movements and so on racket, subsequent party; May also let the patient look that some jokes, the humorous story, listen to section of crosstalks to seek pleasure. These may achieve the shift pain-relieving effect. The relaxation pain-relieving law whole body relaxation may give the human the light pleasant sensation, simultaneously the muscle relaxation may block the ache response. May be called the patient to shut the human to close both eyes, does sighs, yawns and so on movements, bows along with the retroflexion hip horizontal, relaxes the musculi abdominis, the musculi dorsi, the foot muscle, makes the abdominal breathing slowly. Or is called the patient to shut the item in the lonesome and quiet environment to carry on deep and the slow inspiration and the expiration, and along with breathes Lou 1, 2, 3 ......, causes the crisp air to enter the lung cancer, serves the analgetic purpose. The physical pain-relieving law may through stimulate the healthy side which around the ache the skin or corresponds to serve the analgetic purpose, the stimulation method may use the massage, spread the cool pain-killer and so on, may also use each kind of temperature to spread warm, blocks the ache information slightest sign of trouble cerebrum's transmission, if is Leng Shifu with the water bag or the cold wet towel, or places on the warm towel with 65 degrees hot-water bottles to make the hot compress, each time 20 minutes. The above method exchange application or the union application effect is better.
Pain-killer reasonable application and third-level analgetic plan The so-called pain-killer is refers to these to have the alleviation ache function medicine. This kind of analgetic function is only temporary, because they cannot remove cause the ache reason; But cannot deny that stopped pain the medicine to play the vital role truly in the cancerous ache pain-relieving. In the clinical pharmacological treatment, the cancerous ache commonly used pain-relieving medicine has two kinds: A kind of right and wrong anaesthesia pain-killer, may buy directly in the general pharmacy; Another kind anaesthetizes the pain-killer, needs doctor the special prescription only then to be possible to obtain. (1) non-anaesthesia pain-killer The non-anaesthesia pain-killer mainly includes the aspirin, to the acetyl amino-phenol, to different Ding the hydrocinnamic acid 3 medicines. Most situations, non-anaesthesia pain-killer, if uses promptly, to alleviates cancer patient's ache to have the enough curative effect. In the alleviation mildly to the moderate ache, the effect is specially good. To the majority patients, the conventional dosage non-anaesthesia pain-killer and the anaesthesia pain-killer like codein analgetic effect compares, not obvious difference. Therefore the present advocated, if the patient uses the non-anaesthesia pain-killer then to be possible to obtain the analgetic effect, do not use the anaesthesia pain-killer. Because the anaesthesia pain-killer has the big untoward effect. The non-anaesthesia pain-killer also has the compound preparation, the goal is alleviates the medicine certain untoward effects and increases the analgetic effect. The compound pain-killer besides includes the aspirin, to the acetyl amino-phenol or to the different Ding hydrocinnamic acid 3 kinds, but also according to needs to join some chemical additives. Like joins the magnesium carbonate, the aluminum hydroxide to be possible the neutral gastric juice, reduces the stomach uncomfortableness; Joins the caffeine to be popular prepares the medicinal preparation, has reduces the ache the function; Joins the antihistamine class medicine, like the benadryl, the chlorpheniramine and so on, have the hypnosis, the sedative activity, the latter kind of medicine takes suitably in the evening, otherwise causes sleepily, listless. (2) anaesthetizes the pain-killer The anaesthesia pain-killer, was the person plant opium poppy (opium) withdraws in the past, therefore was also called as the opium preparation. But the present, many anaesthesia pain-killers may the synthesized. The anaesthesia pain-killer includes: The codein, the dihydro morphine, methadone, the morphine, the oxygen may the alkone and the oxygen morphine alkone. The anaesthesia pain-killer mainly uses in moderate and the specific weight ache, stops pain the effect to be obvious. Chang Yufei anaesthetizes the pain-killer to apply together, not can only control the varying degree effectively the ache, moreover is helpful to the reduced anaesthesia pain-killer amount used. The anaesthesia pain-killer's most major problem is appears becomes addicted to and the antibiotic nature. Generally speaking, in doctor under instruction, cancer patient after use anaesthesia pain-killer has the opportunity which becomes addicted to be extremely few. When the majority patients use other methods can control the ache, can smoothly stop the anaesthesia pain-killer the use. (3) other kind of medicines This kind of medicine may alone or uses in with the anaesthesia pain-killer the treat cancer patient's ache together. And has some to have own analgetic function, has some to be possible to increase the anaesthetic the analgetic effect, but also has some may reduce the anaesthesia medicine the untoward effect. These kind of medicines include: 1) anti-despondent medicine Like the imipramine, the Arab League onamot for the forest and so on, often use in the ache which the surgery, the radiotherapy, the chemotherapy cause. 2) the main center is popular prepares the medicine If the dextrorotary benzene isopropyl amine and so on, besides increases the anaesthesia medicine the analgetic effect, and has the resistance sleepy untoward effect function. 3) anti-organization according to medicine Like the benadryl, the tran-Q, settle him happily and so on, has the alleviation ache, to stop spits and sleeps soundly the function. 4) anticonvulsant The rising sun tegretal and so on, may alleviate, because the stimulation nerve causes ache. 5) steroid hormone Like Prednisone, the dexamethasone and so on, to alleviate, the constant pain to have the help anxiously. The World Health Organization proposed that “in 2000 relieved the ache for the most cancer patients” the strategic target. It manifested the control cancer ache to become implements the humanitarianism the important remedial measure. in 1984 the World Health Organization invited 28 medicine, the pharmacy and nurses the expert to discuss formulates “the third-level pain-relieving” the plan, its synopsis was as follows: ⅠLevel pain-relieving Is suitable in the general ache. Uses the non-anaesthesia mitigative to add and subtract the auxiliary adjuvant (non-steroid class). Namely: Aspirin 200~1000 milligrams, every 4 hours 1 time, after the food uses, to need the aspirin which the intestines dissolve or to add the antacid. ⅡLevel pain-relieving Is suitable in moderate continues the ache or the ache aggravation. Uses the weak anesthetic to add and subtract the non-anaesthesia mitigative to add and subtract the auxiliary adjuvant. Namely: The codein 30 milligram Canada aspirin 650 milligrams (approximately are equal to codein 30 milligrams), every 4 hours 1 time. ⅢLevel pain-relieving Is suitable in continues the ache intensely. Uses the strong anesthetic to add the non-anaesthesia mitigative to add the auxiliary adjuvant. Namely: Morphine 0.01 gram Canada aspirin, until ache subduction. The morphine gives the medicine way: Oral administration, tongue Next or anal suppository. The auxiliary adjuvant is refers to the calm tranquilizer, the hibernation to work, stably, Prednisone, dexamethasone medicines and so on steroid class, according to the condition need, chooses the auxiliary adjuvant.
National Drugs Surveillance Administrative bureau Gu Weiping the assistant inspector answers: The reason is various. Looking from the current national policy, already not any hindrance anaesthetic reasonable use restrictive regulations, therefore, the cancer pain control level low most primary cause is treats in the idea and the medication custom has the erroneous zone. “Becomes addicted to the fear” to the narcotic the psychology, not only exists in the general patients and the family member, also fetters the primary factor which the medical care personnel apply drugs. Must therefore to the medical care personnel and the patient clarified repeatedly “addictive nature” the correct meaning, differentiates the non-medical goal illegal medication demand (to take drugs) strictly and the medical goal legitimate demand, should not treat as the tolerance the addictive nature. Unreasonable prescription custom namely massive prescription demerol hydrochloride, is also affects the cancer pain control level the primary factor. This revision hemp card's use stipulated that is must limit the demerol hydrochloride the unreasonable use, but recommends the use meconium class medicine to control, the slow release preparation. In addition, the current narcotic controls, the slow preparation price to be excessively high also affects one of promoted use barriers. As for the government, the formulation corresponding policy simplifies the circulation link to reduce the medicine price, simultaneously, the enterprise should also reduce the medicine cost diligently, enables more common people to obtain the effective ache treatment. In brief, hoped that from all walks of life can transform from the idea, completes the ache control work.
Contracted serious illness Chang Yao to go to the hospital treatment, much less was cancer. But Beijing Temple of Heaven Hospital rather raises a research which the courtyard completed recently actually to demonstrate, the later period cancer painful patient is suitable in the home treats, like this its patient ache alleviation rate may reach as high as 98%, quality of life many targets also has the remarkable enhancement. Therefore the expert believed that this method suits our country national condition, should promote by the society. Regardless of being the patient or the family member, should go out the hospital treatment the erroneous zone. Cancer ache is most makes the patient frightened and unendurable. World Health Organization (WHO) lists as the cancer pain control cancer unified plan treatment the key point. Some time ago, the Temple of Heaven hospital rather raised the courtyard to develop “has eased the pain the treatment result research to the critically ill cancer painful patient in the home”. Doctor carries on the track to 32 masculine and 28 feminine critically ill terminal cancer patient, including patients and so on lung cancer, cancer of the intestines, liver cancer, cervical cancer, bone cancer, esophagus cancer and gallbladder cystocarcinoma. Before the treatment, the medical personnel have made the overall check to the patient, and makes the ache degree graduation appraisal separately. To, the critically ill cancer painful patient, according to WHO cancer ache three steps and ladders pain-relieving principle, gives the right amount oral administration or the external use strong meconium class analgesic treatment. In the treatment the basis condition change, momentarily adjusts the medicine dosage. Then presses the ache alleviation again, the appetite, the sleep, the state of mind quality point scale, fixed time carries on the curative effect observation. The result showed that the pharmacological treatment pain-relieving effect is good, alleviates 16 examples completely, the moderate above alleviates 53 examples; The ache alleviation rate reaches 98%. Meanwhile also has the remarkable enhancement in the quality of life, the appetite, the sleep and the state of mind has the enhancement. According to this courtyard expert Director Shao Jun introduced that the later period cancer painful patient treats in the home, really has many advantage. This way both are convenient, and economy, in the specialized medical care personnel or pass through entire section doctor who trains specially under the instruction to be possible to implement. Both can reduce family member many Loughton, and is advantageous for the emotion communication and psychological unblocking, enables the patient in the life which gradually passes to obtain more deathbed cares. May also alleviate our country rather to raise the bed scarce present situation.
Professor Cai Zhiji answers: The long-term clinical practice proved that take eases the pain the treatment as the goal, under the meconium class medicine convention dosage has the phenomenon which becomes addicted to is very rare. The overseas two item of big sample investigation's result indicated that produces becomes addicted to the phenomenon distinction only to account for 0.029% and 0.033%, i.e. every 10,000 example long-term use meconium class medicine stops pain in the patient, becoming addicted to is only 3, therefore, draws “the cancer painful patient long-term use meconium class medicine becomes addicted to rarely” the conclusion to have the clinical practice basis. In explained this phenomenon when truth should note, the medicine function and organism functional condition concerns this rule, namely normal and under the pathological state has the difference to the medicine response. In the cancer painful patient central nervous system has the intense ache infection, uses the meconium class medicine under this pathological state, its analgesia potency obtains the full display, but happy namely “flutters” the feeling to step down the very secondary position. In turn, the normal person does not have the chronic fierce ache condition, if the long-term use meconium class medicine, in its function ambiguity good is at the same time the analgesia potency displays without knowing where to begin, but its bad is at the same time the addictive nature has the opportunity to give full play. Moreover, after the medicine will enter human body's drug efficacy also to receive an its medicine generation of dynamics to affect, the injection medicine intravenous injection will make the blood medicine density to advance rapidly particularly, in the brain the density obvious markup will also surpass the analgesia density which will need, will achieve causes “flutters” the feeling high potency. In the early-1980s WHO proposed that since "Cancer Three Steps and ladders Pain-relieving Plan" in the 20 years, internationally has promoted with great effort in the chronic cancer painful patient uses the morphine to control, the slow release oral administration preparation (US to execute Kangting for representative who controls releases preparation), this kind of preparation applies the high tech method to cause the medicine to absorb at the gastro-intestinal tract slow release, the blood medicine density can maintain the stable analgesia density in the long time, will not cause the blood medicine density to rise rapidly causes “flutters” the feeling density.
Some medicines will have the drug resistance, along with the condition extension, more will possibly stop on the need hurts the medicine, for example the cancer pain, some patients just started to eat one piece to suffice, along with cancer's proliferation, the ache spot have been getting more and more, the possible need bigger analgesia medicine, just to start our some patients eats one piece, we will internationally have the report, one day will even eat 100 pieces, now bears the medicine along with the medicine appearance the words, you may change other one medicine, you may also change other one way, for example some patients will eat the oral administration the anticancer treatment pain medicine, he eats quite uncomfortable, must eat such massively, sometimes after the shift, will have the gastro-intestinal tract change, the patient eats later to be disgusting, belly bulge specially fierce, if did not eat hurt awfully, therefore we have now introduced the new ache method of treatment, we had one kind of tube to put directly to the brain accumulate in the fluid, his medication only then we applied drugs normally 34%, like this might reduce many side effects, not only he might guarantee continued medication, moreover might also according to yours need, if evening sore fierce, might give the medicine, this kind of treatment was enters toAfter your body, does not affect your any life, also does not affect you to take a bath, oneself do not stop gives the medicine toward the body, to has needed to apply drugs increases, through in vitro remote control may solve.
The World Health Organization proposed that “in 2000 relieved the ache for the most cancer patients” the strategic target. It manifested the control cancer ache to become implements the humanitarianism the important remedial measure. in 1984 the World Health Organization invited 28 medicine, the pharmacy and nurses the expert to discuss formulates “the third-level pain-relieving” the plan, its synopsis was as follows: ⅠThe level pain-relieving is suitable for the general ache. Uses the non-anaesthesia mitigative to add and subtract the auxiliary adjuvant (non-steroid class). Namely: Aspirin 200~1000 milligrams, every 4 hours 1 time, after the food uses, to need the aspirin which the intestines dissolve or to add the antacid. ⅡThe level pain-relieving is suitable in moderate continues the ache or the ache aggravation. Uses the weak anesthetic to add and subtract the non-anaesthesia mitigative to add and subtract the auxiliary adjuvant. Namely: The codein 30 milligram Canada aspirin 650 milligrams (approximately are equal to codein 30 milligrams), every 4 hours 1 time. ⅢLevel pain-relieving; Is suitable in continues the ache intensely. Uses the strong anesthetic to add the non-anaesthesia mitigative to add the auxiliary adjuvant. Namely: Morphine 0.01 gram Canada aspirin, until ache subduction. The morphine gives the medicine way: Oral administration, hypoglossis or anal suppository. The auxiliary adjuvant is refers to the calm tranquilizer, the hibernation to work, stably, Prednisone, dexamethasone medicines and so on steroid class, according to the condition need, chooses the auxiliary adjuvant.
Regarding the cancer patient, most frightened is not the death, but is the ache. But, is cannot avoid the ache all cancers to the later period? The Temple of Heaven hospital rather raises courtyard Dr. Wang to tell reporter, the cancer patient has the cancer pain the symptom to have the tumor reason, also has the patient to the ache sensitive reason. Speaking of the tolerance, some patient tolerance does not think the ache, but some thought that is very sore. Speaking of the tumor, some tumor ache, some tumor not too ache. Mainly has liver cancer, the cancer of the pancreas and the bone compared with ache cancer shifts. But feminine cervical cancer, the ovarian cancer are friends with some relatively, the lung cancer also has besides the ache feels suffocated the feeling, often is not hurts uncomfortably, but suppresses uncomfortably. 90% cancer painful patient may the indolence To control the cancer pain effectively, as early as in 1982, the World Health Organization (WHO) proposed famous "Cancer Three Steps and ladders Pain-relieving Guiding principle", according to this principle, with the existing analgesia medicine, may enable 90% cancer patient's ache to alleviate. Our country in December, 1990 introduced officially this principle the home. It is known that at present Beijing society healthcare department the free analgetic treatment which provides to the cancer painful patient, follows is three steps and ladders pain-relieving plan. According to this principle, the terminal cancer stops hurts uses 3 steps and ladders generally the drugs, based on this adds and subtracts the union medication. Beijing Temple of Heaven Hospital rather raises the courtyard Director Shao Jun introduced that the so-called three steps and ladders pain-relieving plan, is by specialized doctor, in makes the correct appraisal after the cancer pain's nature and the reason, divides into according to the ache fierce degree the ache the light, medium and heavy three ranks (steps and ladders), and defers to the ache the different rank choice different medicine. Selects the non-meconium class medicine to the mild ache's patient, selects the weak morphine class medicine to the moderate ache patient, needs to use the morphine preparation to the specific weight ache's patient. Beijing Temple of Heaven Hospital rather raises the courtyard Dr. Ma Zhen Shan gave an example saying that for instance hurt in view of the bone, adds the non-steroid body class drugs, the related nerve hurt, adds the clothing nerve pain-killer. Dr. Ma Zhenshan and Dr. Chen Fan explained in detail to reporter how three steps and ladders pain-relieving plan is applies on clinical: When sees a doctor to the patient, how listens to the patient is to carry on the indication to own ache, and defers to his indication to classify, then acts appropriately to the situation. For example: A 72 year-old person's condition is the lung cancer later period, in addition the bone shifts. The patient said that after his, back, the thigh, the crotch ache, looks like the acupuncture same ache to feel, moreover also has receives an electric shock the feeling. By now doctor inquiring about health person, if divides into the ache 10 levels, you thought that which you do belong first-level. The patient thought that he possibly occupies 5, 6 levels of appearances. Such doctor may judge patient's ache to belong to the moderate ache, may use the weak morphine class medicine, if the strong pain decides. Moreover, each time opens for patient's dose generally is a half month-long dose, therefore, every other a half month patients must come the hospital recipe.
First, the old father results in the cancer, the request relates the hospital to buy the anaesthesia pain-killer “Du suddenly”, after prepares, uses. But doctor said that cannot use “Du suddenly”, why is this? Analysis: The World Health Organization does not advocate the use with the Chinese Country Medical department. The reason has three; first, its side effect is too big, the toxicity is too strong, overseas got rid early. Second, it does not conform to the World Health Organization cancer ache third-level steps and ladders pain-relieving principle of reatment, namely “oral administration medication” principle. Third, the present other analgetic curative effect is good, the side effect few medicines and the method are many. The later period cancer painful patient “endures” is a moral excellence, when patient just before the end only then shows the kindness of heart to use the pain-killer to the patient the Chinese tradition viewpoint is wrong, not humanity. We advocated that the ache patient cannot endure suffering, the patient relative wants to believe that the patient has the ache, said that has the multi-pains on the multi-pains; The ache is not fearful, the method of treatment are also many, is very simple. The simple the means were an oral administration pain-killer, the patient have been comfortable, is not painful. Second, does not stop pain for the cancer painful patient the treatment is wrong, when cancer painful patient ache outbreak gives the medicine to be how also wrong? Analysis: The terminal cancer patient's ache is the chronic long-term ache, its treatment's goal is to let the patient not be for a long time painful, and, has the dignity life comfortably. Only then gives the medicine according to the stipulation time interval, if every 12 hours one or 72 hours one time give the medicine, no matter for medicine at that time patient whether do manifest suddenly the ache, like this can guarantee that the ache alleviates continuously, patient's quality of life can enhance. “fixed time gives the medicine” is the principle which the World Health Organization cancer ache third-level steps and ladders pain-relieving method does not allow to change. When the patient ache cannot endure only then gives the patient to use the pain-killer the method is unscientific. Third, why starts to take aspirin one one piece to be able to stop pain for 4 hours, afterward 2 pieces actually only could stop pain for 3 hours, afterward traded a better medicine was also this, was getting bigger and bigger with the dose, stops pain the time to be getting more and more short, the effect was getting more and more bad, whether “to become addicted to”? Analysis: Actually the truth is very simple. First, possibly was along with the condition development, the ache aggravates. Second, was takes the identical medicine for a long time, the patient has had “the drug resistance”. This has the strict difference with “the addictive nature ". “the drug resistance” is the patient takes the identical medicine for a long time, only then gradually the incremental dose to be able to achieve the original analgetic effect. “the addictive nature” does not give a thought to the dignity obtains “the medicine” the desire and the behavior for the pursue euphoria. Cancer patient will not become addicted to, because the ache and the tumor existence will be the reality, the ache will be “will become addicted to” the natural antagonist compound. We discovered that causes the ache alleviation after the effective anti-tumor treatment, the pain-killer may stop the use immediately, but does not have any “the addictive nature”.
The cancer pain is because the malignant tumor destroys the patient organism organization, the stimulation nerve ending causes ache. As a result of each kind of reason, the cancer pain's formation rate is not very same, bone cancer (including osteosarcoma and transferability tumor) is 85%, the oral cancer 80%, the uninary system tumor 70%, breast cancer about 50%, the lung cancer 45%, the lymphatic system tumor about 30%, sends in the intermediate stage, the terminal cancer. Discovered according to the Shanghai Medical college attached two hospital's 100 example liver cancer patient ache's degree that the extremely fierce pain accounts for 7%, and the specific weight pain account for 47%, the mildness 30%, indolence 10%. The cancer pain appears much in the intermediate stage, the later period patient, the cancer pain degree besides with the tumor itself to organism damage situation related, also has the close relation with patient's psychology. According to the observation discovery, did not know that the condition and the mood optimist ache is light, but knew that the condition and the mood melancholy, the cancer pain appears early, is also serious, even the patient will have the pessimistic thought that obviously the mental healing will have the noticeable function to the cancer pain. The cancer pain has the somatalgia, splanchnodynia, neuralgia and the storm feels pain and so on, this spot which, tumor infringement scope, with nerve branch's relations as well as the analgetic medicine's type occurs with the tumor concerns. Therefore, in treats in the cancer pain to observe World Health Organization's stipulation strictly, divides three stage medications, namely: Uses the non-hormone anti-SARS analgesic first, following uses the weak meconium analgesic, finally only then uses the strong meconium analgesic. In addition the available medicine blocks method pain-relievings and so on nerve and surgery cut-off nerve.
The cancer pain is one serious symptom merely, its basic principle of reatment should be treats the symptoms and the causes, namely treats the cancer pain to take stopgap measures, treats cancer to effect a permanent cure, takes stopgap measures to effect a permanent cure provides the optimum condition, the two supplementary can have the better treatment result. In cancer pain treatment's each method, the pharmacological treatment is most basic, is most effective, the most commonly used method. Especially the early mild cancer painful patient should use the pharmacological treatment. Because the pharmacological treatment has, the function to be rapid effectively, the risk is small, expense reasonable and so on merits. The basic principle defers to the special details formulation individual therapeutic schedule. Before choice pharmacological treatment ache symptom or other symptoms, must determine that causes the ache specific reason, the appraisal ache intensity and the nature, then chooses the medication again. The pain-relieving should the dosage plan and the non-wound treatment method starts from the simple, and close observation treatment result. Treats the cancer pain to have three broad heading medicines:①Must from body class anti-SARS analgesia medicine namely common analgesic;②Meconium class analgesic;③Auxiliary analgesic, sedative and trophic nerve medicine and so on. the l. mild cancer pain may endure generally, can the normal life, the sleep basic not receive disturbs, should defer to the first steps and ladders treatment. The first steps and ladders treatment is in principle the oral administration must from the body class anti-SARS analgesic, this kind of analgesic function in the end, has allays a fever the analgesia anti-SARS effect, can suppress the hypothalamic prostaglandin synzyme the production, reduces prostaglandin E the synthesis and the release, shifts patient's ache to the prostaglandin content high bone to be effective. Has the aspirin, the paracetamol on behalf of the medicine, to hold his forest and so on. The aspirin start dosage is 250-500 mg/time, most large dose 1000 mg/time, the every 4- 6 h heavy clothing applies drugs one time, then serves the analgetic purpose. The paracetamol takes orally 1 time0.3- 0.6 g/time, 0.6- 1.8 g/d, the treatment course is not easy to surpass 10 d. Holds his forest to take orally 25 mg, daily 3 or suppositories 50mg/time, daily 2 times. Should also replace the medicine type frequently in the treatment, like disperses the pain, the cloth Luo river fragrance, the profuse cloth fragrance superiorly and so on, reduces the gastro-intestinal tract complication and the untoward effect. 2. the moderate cancer pain often was the long-enduring ache, the sleep has received the disturbance, the appetite has the decrease. This kind of ache patient must apply the analgesia medicine, but applies drugs should adopt in principle gradually to the second steps and ladders transition principle, namely while gives must from body class anti-SARS analgesic, gives the analgesic auxiliary, like Qu Maduo or weak effect meconium class analgesic, like codein, dextrorotary third oxygen fragrance and so on. In the evening may take the tranquilizer and the sleeping draught and so on. The pain overcomes is one kind must allays a fever the new medicine from the body class force pain-relieving and the moderate anti-SARS, is mainly through suppresses the prostaglandin the synthesis, may with the opium receptor union, not have the addictive nature. 30 mg pains overcome the analgetic function to be equal to the 12mg morphine, it uses in the moderate cancer painful curative effect good medicine. The strong pain decides (AP-237) to have the effect quick merit, is suitable in the moderate cancer painful patient. 3. the specific weight or the unendurable fierce ache sleep and the diet receive the significant disturbance, in the evening the human rests the difficulty, the ache aggravating. This time with common analgesic already basic invalid, has eased the pain the function with other analgesics or the weak effect meconium class analgesic. The specific weight fierce ache should by the second steps and ladders to the third steps and ladders treatment transition, use the strong effect meconium class analgesic regularly, what at present the mouth takes medicine is commonly used is US executes Kangting (i.e. morphine to control releases piece), each piece including morphine 30 mg, each time the l-2 piece, every 12 h takes orally one time, if cannot take orally time, may pass through the anus to give the medicine. Other strong effect meconium class analgesic has the morphine, the hydrochloric acid dihydro etorphine, US to disperse the alkone left, pai for ding, Fentaini, Uncle Ding Fei, Ding Bingnuo fei, nan and so on. The analgesia for the morphine alkanes synthetic drugs, the excited k opium receptor oppresses the anti-U opium receptor newly, to breathes suppresses weakly, the dependence is small, the analgesia intensity for morphine l/4- l/3, may take for a long time, oral administration each time 25-50 mg, when necessity every 3-4 h takes 1 time. The World Health Organization designs simply, effective, the recognition, the reasonable steps and ladders therapy to be possible to enable 90% cancer patient's ache to obtain the effective alleviation, 75% above terminal cancer patient ache can relieve. When pharmacological treatment should pay attention to the following 5 requests, namely oral administration, on time, according to steps and ladders, individual difference medication. Attention nuts and bolts.
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