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.
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.
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.
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.
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.
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.
North net news: The life cannot endure the ache has 4 kinds, first one is the terminal cancer. The statistical data demonstrated that in the terminal cancer patient has 75% all day by the ache puzzle. Injects Du for them is suddenly the best analgesia means? The Tianjin Tumour hospital's expert believed that this in fact is one kind of erroneous zone, in their opinion, the oral administration morphine may alleviate 90% above terminal cancer patient's pain, therefore the best analgesic is the morphine, but non-demerol hydrochloride. The statistical data indicated that at present our country approximately has 2,000,000 person of cancer new morbidity person every year, approximately some 1,000,000 people have the varying degree ache, hurts unendurable accounts for 25%~30%. At present, regarding the terminal cancer patient, many doctors will inject Du suddenly. But the city Tumour hospital concerned expert pointed out that the massive clinical cares confirmed that 90% cancer painful patient may through the oral administration morphine alleviation ache, 10% need to unify the other method control difficult ache, and will not appear “becomes addicted to” the phenomenon. Regarding all cancer painful patient, should according to the scheduled time medication, but is not when the ache appears once more gives the medicine.
In 1999 in the whole world narcotic medical service consumption place, China arranged at 102nd. Compares with neighboring country Japan, in 1999 the Japanese morphine medical service consumption amounted to more than 900 kilograms, our country is only more than 100 kilograms, but our country population was Japan's more than 10 times, actual morphine average per person consumption both countries differed nearly 100 times. What creates this kind of huge disparity the reason is? Reporter interviewed partial basic unit medical service unit's clinician on this question, and has consulted the related ache control expert, the generalized analysis indicated that affects the cancer pain treatment the reason is various, but the most important question is the general medical personnel and the patient exists generally “becomes addicted to the fear” to the meconium class medicine. This kind “becomes addicted to the fear”, is the meconium class medicine use chief obstacle, is also in the ache treatment biggest bottleneck. The production “becomes addicted to the fear” the primary cause is in doctor the universal existence some wrong traditional ideas, here, it is necessary to clarify. Body dependence ≠ spirit dependence To the meconium class pain-killer's fear is because widely exists the erroneous picture, thought that the body dependence (physiological dependence) equates in the spiritual dependence (becomes addicted to, medicine dependence). After the physiological dependence is refers to meconium class analgesic long-term usage period of time, forms endures. Its characteristic performance is, applies drugs after repeatedly, affects the potency to drop, the response time reduces, needs the incremental dose or the reduction can maintain the treatment result for the medicine time. The physiological dependence's production belongs to the normal physiological Pharmacology phenomenon. The spiritual dependence is one kind of reflection psychological abnormality the behavior performance, its characteristic is pure take pursues energetic enjoyment as the medication goal, resorts to all means with cannot help but to long for that obtains the medicine; After the medication, may obtain one kind specially well satisfied “the euphoria”, thus has formed ingrained in the psychology to the meconium class analgesic dependence. Has one kind of situation on clinical to be possible to be called the vacation “to become addicted to”, because uses for to describe one kind the ache not to be able to obtain the behavior change which the effective treatment causes, is called the medical source syndrome, this and sends the meconium class medicine spirit dependence behavior to be similar especially, but the nature is different. Therefore, should differentiate the physiological dependence correctly with the difference which becomes addicted. Cannot, because the constant pain patient uses the meconium class pain-killer to produce endures treats as them becoming addicted. If cannot differentiate the body dependence and the spiritual dependence, will cause the ache patient not to be able to obtain the enough analgetic treatment to suffer the nonessential pain. Narcotic ≠ narcotics The medical application ≠ abuses The so-called drugs, are refer to use for to treat or the prevention disease's material; But the narcotics are point out in the non-medical goal but the long-term usage can produce the dependent material repeatedly. Everything lists as the state regulation the medicine, the reasonable use is the drugs, the illegal use is narcotics. So-called abuses, is refers to using the medicine achieves the feeling of satisfaction, produces is no use to the treatment effect. All narcotics have the possibility to abuse, but the normal medical application is not abuses, must and illegal abuses the reasonable use distinguishes strictly. Specially cannot to seek relieves the ache to request to obtain the treatment patient to regard is the drug addict, also cannot increase the anaesthesia pain-killer dosage to take for is substance abuse, cannot delimits the narcotic and the narcotics the equal sign, but limits patient's right use. The ache patient has the spiritual dependence to be extremely rare The clinical research discovery, the meconium class medicine in the standardization service condition, the ache patient presents the phenomenon which becomes addicted to be extremely rare. The possible explanation is, when the ache vulnerability stimulation along in the transmission ache's neural pathway upward process, ache patient's in vivo has produced the special opium receptor. These acceptor dispersion in had among the meconium class material, dispersed entered in vivo the alleviation ache medicine. But does not have the ache individual not to have these special acceptors, this time, any enters in vivo majority of the meconium class material directly with brain's in acceptor union, caused in the brain the meconium class medicine density to advance suddenly, increased the possibility which became addicted. In addition, becomes addicted to the formation rate and the medicine for the formula type related, the direct intravenous injection make the blood medicine density to advance suddenly, easy to cause to become addicted. Uses the meconium class medicine in the constant pain treatment to control releases the preparation, the medicine slowly releases in the gastro-intestinal tract, causes the blood medicine density to a certain extent maintains constant. Therefore, in does not have in the substance abuse history patient's ache course of treatment, meconium class medicine's becoming addicted to is rare. An entire US's investigation showed: 10,000 examples with meconium class pharmacological treatment several Zhou Zhishu in the month patient, the only 22 examples have the spiritual dependence, these patients once had the substance abuse history. Other 11 882 examples with in the meconium class pharmacological treatment's in-patient, only some 4 examples have the spiritual dependence. Therefore may say that becomes addicted to does not occur nearly in the ache patient, including cancer patient. Expert appeal: Renewal medication idea, breakthrough treatment bottleneck The cancerous ache is a global scale serious public health question. Because exists generally so-called " addictive nature " the wrong traditional ideas, enables many patient's aches not to obtain the effective alleviation. The experts pointed out that because is afraid the patient to become addicted to or the worry anaesthetic inflow illegal channel, gives up eating for fear of choking, because in use frequently dosage insufficient influence pain-relieving effect, even evades does not use, this is the humanity does not make the law to the ache patient. Thought that the ache treatment is “the headache medicine head, the foot painful medicine foot”, is also one wrong idea. If is only looking from the angle which stops pain temporarily, the ache treatment as if is only one expedient measure, namely so-called “takes stopgap measures”. But in fact, because has controlled the ache as well as the physiological function disorder which causes by the ache, if the improvement psychology function condition, the improvement sleep, reduces anxious, improved patient's quality of life, this is also an ache treatment important achievement. Proposed at the ninth world ache congress “the ache is one kind of disease, but is not only one symptom” the new idea, the medical worker must enhance the ache treatment to treats disease to treat same likely knew highly, the policy maker and even the populace must overcome the ache treatment barrier, enables the ache patient to obtain the full treatment. The WHO medicine dependent Expert board has published stated: The request “through to the medical worker, the health devices and all public's education promotes to use the meconium class pain-killer reasonably, guaranteed that has the reasonable medical needs patient to obtain the full treatment”. China's general medical workers must renew the medication idea, the breakthrough medication bottleneck, causes China's ache treatment level and the international trail connection.
Now domestic and foreign tumor specialist very much pays attention to the ache question, some hospitals even regard as the ache “the fifth life symptom”, i.e., doctor wants to care likely patient's blood pressure, the pulse, the breath and the body temperature pay attention to patient's ache question equally. Do not think “, so long as cancer certainly will have hurt, the ache was the normal phenomenon.”The ache is in itself one kind of disease, but is not only cancer's symptom, clinicians should give to take seriously. The ache will cause the cancer patient anorexia, the mood depressed even to suffer from the depression, regardless of the patient or family member's quality of life without knowing where to begin guaranteed. Therefore, takes medicine stops hurts is each cancer patient's basic right, must respect. Cancer patient stops hurts the medicine to become addicted to the probability to be inferior to 1/1000 In real life, because the people to stop hurt the medicine existence misunderstanding, enables this right not to obtain the safeguard. “thought that will stop hurts the medicine to cause the patient to become addicted to” will be in these misunderstandings most prominent. “three steps and ladders cancer pain-relieving plan” the first steps and ladders medicine, is take medicines and so on aspirin as representative's non-meconium class pain-killer, if treats invalid, needs to use the second steps and ladders medicine, namely the weak meconium class medicine, for example the codein, the wonderful graceful fourth place, this time may the 12th steps and ladders medicine union use, the dose be possible to reduce, if the curative effect were still not this time ideal, needs to use the third steps and ladders medicine, namely strong meconium class medicine, like morphine. Director Di pointed out that so long as according to the science analgetic plan, cancer patient will take medicine “will become addicted to” the proportion not to surpass 1 ‰. Cancer patient can also stop in the home hurts Cancer's order of severity with the ache degree is not completely consistent. Some cancers will cause very much the fierce ache in the early time, will cut may not, because the patient will belong to the early patient, but will imitate “three steps and ladders plans” mechanically, thought that the early time cancer patient must use the first steps and ladders medicine. Actually to use what medicine, must the seeing a doctor person's ache degree as well as the medicine curative effect. In recent years, the pain-killer research made the progress unceasingly, “three steps and ladders” the medicine belonged to the oral administration medicine, the patient may treat in the home, the curative effect was not worse than the injection, moreover maintained for a long time. Moreover, stops pain pastes and so on new dosage-form to be published lets the treatment be more convenient. For all this, still some aches took medicine invalid. In cancer ache by nerve ache most unendurable, cancer of the pancreas or when other abdomen tumor oppression abdominal cavity nerve plexus, shifts to spinal column's tumor oppression spinal cord, can cause the severe pain which not rests day and night, these patients this time often need so-called “the fourth steps and ladders pain-relieving” the treatment, the anesthetist even are surgeons, may through the cut-off or the damage nerve means alleviation ache.
After breast cancer surgery, because armpit's vein is tied up, the blood backflow will have the barrier, will thus have dropsy and the ache frequently; In addition, when the tumor shifts to the bone or other spots, also possibly causes the corresponding spot fierce ache. This will often increase patient's pain, will reduce their survival quality greatly. In the treatment, is long regarding the course and the ache light cancer patient, should adopt the psychotherapy and the physiotherapy stops pain, by now the family member could play the role is unreplaceable. First, they may unify each cancer's method of treatment, suggested how the patient does carry on own adjustment, completes the eat three meals a day and the essential recovery training. Next, the family member can help the patient to relax the whole body to obtain the light pleasant sensation. Let the patient close both eyes, does yawn movements and so on sighs, has, bows horizontal, the relaxation musculi abdominis along with the retroflexion hip, the musculi dorsi, to make the abdominal breathing slowly. Perhaps may suggest that the patient shuts the item in the lonesome and quiet environment to carry on deep and the slow inspiration and the expiration, lets the fresh air enter the lungs, serves the analgetic purpose. Third, with the massage, spreads the cool pain-killer the method pain-relieving, or uses each kind of thermal stimulus the method pain-relieving. For instance may use 65℃ the hot-water bottle places on the wet towel to make the partial hot compress, each time 20 minutes, can make certain analgetic progress. Fourth, eats food the latter 2 hours, may let the patient sit on the comfortable chair, closes both eyes, recalled oneself are willing to think any matter, each time 15 minutes, afterward again shut the item to sit in meditation 2 minutes; May also act according to patient's hobby, elects to play some cheerful musics, lets the patient on the one hand appreciate on the other hand does along with the rhythm strokes, claps and so on movements; May also let the patient look at some jokes, or listens to section of crosstalks. As for minority to ache control not satisfactory breast cancer patient, may install analgesia remedial measures and so on automatic control analgesia pump to carry on the treatment. However, even if treats in the home, should also maintain the close relation with the hospital, best guarantee every week 2-3 time hospital revisit, once so that can have the panic stations, can obtain the prompt regular treatment.
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