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.
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.
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.
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.
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.
Mechanism which (cancer pain) produces about cancer ache, at present thought that has three ways, namely: Cancer develops the result ache, diagnoses and the ache which as well as cancer patient the treat cancer causes infects the ache which concurrently, constant pain disease and cancer ache syndrome occurs. In these three ways, 75%~80% patients are because the tumor invasion soft tissue, the marrow as well as the nervous system cause, 15%~20% are produces in cancer's diagnosis and the course of treatment, 5%~10% pieces are because has merged ache disease. First, cancer develops the result ache 1st, cancer infringement Nervous tissue cancer cell through axilemma around lymph road or along nerve around resistivity weak spot infiltration, then again to nerve axis cylinder invasion. Cancer infringement nerve causes the ache has three reasons:① In the axilemma nerve fiber is infiltrated the strangulation result;② The cancer cell releases certain sends the painful material, like 5- hydroxy colorsThe amine, slow stirs up functions and so on peptide, histamin to cause the ache in the peripheral nerve;③ Trophic nerve's blood vessel is stopped up by the cancer cell, the nerve fiber is at the ischemia condition to cause the ache. On clinical, the metastasis has the stubborn ache, often appears by neuralgia's form, its nature is the sharp pain, often diffuses to the body surface innervation scope. When the cancer lump infiltrates to the abdominal cavity nerve plexus, the mesentery nerve plexus, the shinbone nerve plexus, the ache spot becomes not explicitly, the ache assumes the endurance. 2nd, outside the hard membrane shifts, the spinal cord to oppress outside the hard membrane the shift is breast cancer, the prostate gland cancer, the lung cancer, the multiple myeloma, malignant melanoma, the kidney cancer's common complication. Outside the hard membrane shifts when the cancer oppresses the spinal cord, ache limitation in cone, close median line. When tumor infringement nerve root, then presents the nerve root to distribute the region the sharp pain or the stabbing pain, the ache assumes the belt-shaped distribution, if does not treat, then may have the spinal cord oppression syndrome, is accompanied by the feeling, the movement, the nervus autonomici change or the barrier. 3rd, when the cancer infringement lumen internal organs malignant tumor causes the lumen internal organs function barrier, may have the ache, its characteristic is not explicit localization, periodic and the repeatable outbreak, often is accompanied by disgusting, the vomit, the distension of the abdomen. The biliary duct, the pancreatic duct narrow or blocking often causes the intense ache; The carcinoma of uterus, the ovarian cancer oppression and infringement ureter may also cause the hard to endure colic. 4th, cancer infringement vascular system cancer lump oppression, the jamming or infiltrate when the artery, the vein, the lymph vessel may cause the ache. 5th, regardless of cancer infringement skeleton is the primary bone tumor or the transferability bone tumor, may have the hard to endure ache. 6th, cancer itself secretes sends the painful material cancer cell necrosis disintegration to release the tumor necrosis factor, the prostaglandin, 5- hydroxy tryptamines, slow to stir up the peptide, the histamin and so on to send the painful material to cause the ache. Second, after cancer diagnosis and treatment, causes ache 1st, the diagnosis inspection causes the ache marrow puts on attracts the biopsy technique, the lumbar vertebra puncture method, wound and so on each kind of endoscopy inspections, may give the cancer patient to bring the ache. 2nd, after surgical operation, after the ache surgical operation damages the nerve as well as the technique, the scar forms the small neuroma to be possible to cause the ache; After the technique, the scar luan shrinks pulls pulls, the cancer lump recrudescence to pull pulls the organization to be possible to have the ache. 3rd, after radiotherapy, the ache radiotherapy may cause the organization to have the fibrosis, the oppression or pulls pulls the nerve and the ache sensitive organization has the ache. After common radiotherapy, the ache syndrome has the radioactive nerve plexus to get sick with the radioactive myelopathy. In addition, after the radiotherapy, produces the mycodermatitis, dermatitis, the enteritis, the belt-shaped herpes, the radioactive pneumonia and so on may cause the ache the occurrence. 4th, after chemotherapy, time ache chemotherapy venipuncture; After hepatic artery irrigation chemotherapy and abdominal cavity chemotherapy, causes proliferating abdominal pain; After the chemotherapy, causes phlebitis, mycodermatitis, enteritis, hemorrhagic cystitis; As well as the chemotherapy medicine's poisonous side effect causes polyneuritis and so on. 5th, after involvement treatment, ache each kind (for example puts on after the skin internal organs puncture method after Pi Gan, after Pi Shenchuan and so on); Moves the venipuncture after the skin to set at the tube technique and so on has creates the involvement treatment technology, may have the ache. 6th, after hormone treatment, after ache hormone treatment, the ache is called the steroid pseudo rheumatism, is refers to the cancer patient after accepting the sugar cortical hormone treatment, the whole body muscle, the tendon, the joint and the bone have the cauterization type ache, specially the intercostal muscle has the saccadic ache, simultaneously accompanies the general malaise, soft and weak and gives off heat, sometimes is also accompanied by the psychology and the dysphrenia. 7th, after immunity treatment, after ache common immunity treatment, causes the ache refers to the acute ache which the interferon causes, this kind of ache performance to give off heat, the shiver, myodynia, the arthralgia and the headache. 8th, after analgesia treatment ache cancer ache patient in analgesia course of treatment, may also have the new ache. The intramuscular injection and the hypodermic injection analgesic may cause the ache; Some patients after use meconium class medicine, may have the repeatable entire headache and so on. Third, merge infection, constant pain disease as well as cancer ache syndrome 1st, cancer merge infection causes the ache malignant tumor patient is extremely easy to be accompanied by the ache concurrently the infection, this kind of infection often by the bacterium, the fungus or the virus causes. 2nd, cancer merge constant pain disease cancer merge constant pain disease is refers to the cancer patient simultaneously to contract each kind of arthritis, the fascutis, cervical vertebra sickness, the waist intervertebral disc prominently sickness and so on. 3rd, cancer merge cancer ache syndrome cancer merge cancer ache syndrome is refers to cancer patient to have cancer ache syndrome concurrently, invades and the spot, the organizational structure difference according to the tumor, appears has certain characteristic ache. Generally the treatment relative difficulty, needs the complex therapy. 4th, the psychological factor urges cancer patient ache degree aggravating as well as a hindrance cancer ache treatment result substantial clause is the psychological factor influence, mainly includes: Restless, angry, despondent and so on three kind of psychological factors.
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