Cancer pain-relieving medicine main minute three broad headings: Non-meconium class, meconium class and auxiliary medication. (1) non-meconium class:①Non-steroid body class anti-inflammatory agent: Including big catkin willow acids medicine (aspirin) and non-big catkin willow acids medicine (cloth Luo river fragrance);②Paracetamol. (2) meconium class:①Weak meconium class: Take the codein as representative, but also has the dextrorotary third oxygen phenol and the hydroxy tests the alkone;②Strong meconium class: Take the morphine as representative, commonly used has the oral administration morphine ordinary piece and controls releases the piece, as well as Ding Bingnuo Philippines, Fentaini, symoron, demerol hydrochloride and so on. (3) auxiliary medicine:①Anticonvulsant: Tegretal, third propyl-acetic acid and so on;②Anti-despondent medicine: Arab League Mi Tilin, imipramine and so on;③Antianxietic: Benzene two nitrogen mixed Zhuo Lei, stable, phenol thiazide and so on;④Cerebral cortex steroid class.
Gives the analgetic medicine on time to the cancer patient, is must defer to the medicine the response time, stipulated the time-gap gives the medicine, but is not only in the patient ache time only then gives the analgetic medicine. The reason is as follows: 1st, after first for medicine, requires certain time to be able to achieve the effective blood medicine density, particularly controls releases (slow release) the medicine, if the morphine sulphate controls releases the piece to be able to achieve the effective blood medicine density for the medicine latter 1 hour. In this “blank time”, if for the fast-acting medicine, the patient still do not endure the ache. 2nd, the ache often is accompanied by the mood, the psychological change, after the ache appears, only then gives the pain-killer, often needs to give compared to a maintenance pain greater dose cannot achieve analgetic the goal. 3rd, when patient ache only then the line stops pain, often needs to give the fast-acting analgetic medicine, but so gives the meconium class medicine often to cause the blood medicine density intense large fluctuation, increases the untoward effect. Therefore, should choose the persistent effect to control as far as possible releases the dosage-form like morphine sulphate to control releases the piece (US to execute Kangting) and so on, gives the medicine on time, but is not on demand gives the medicine, like this can guarantee that maintenance effective, steady blood medicine density, guaranteed that the ache alleviates continually, and is not easy to have the energetic dependence.
Cancer ache is a universal worldwide basis question, according to the World Health Organization (WHO) the statistics, 30%-50% cancer patients is accompanied by the varying degree the ache, because the entire society, even the medical personnel to this question understanding insufficiency, the cause around the world have 3,000,000 - 5,000,000 cancer patient long time to suffer the ache to suffer cannot obtain the effective treatment. In order to improve cancer patient's quality of life, WHO established the cancer pain in 1982 in Italy to treat the Expert board, after the discussion thought that the application existing and might relieve the majority cancer patient's ache for the number limited analgesia medicine, and proposed that “achieved to 2000 in the world scope causes cancer patient was not painful” goal [1]. Our country Medical department responded positively this summons and has taken a series of measures, like conducted the nationwide study group, the seminar; Provide guidance document and study material [1-3]; Adjustment narcotic supply policy; The organization develops develops some narcotic the new variety, if the morphine controls releases the piece. In order to enable the Foshan area to achieve WHO to set “the goal”, it is necessary to make an investigation to the Foshan area cancer pain medication present situation, in order to take further measure for the Department responsible for the work to provide the objective beneficial data information. 1 material and method Uses 1993-1995 year all previous years consumption stupefactive analgesic variety which, specification and schedule of quantities and about study and implementation independently designs “guiding principle” situation 10 question questionnaires, issues separately by the sanitation bureau medicine policy branch the Foshan area (including Foshan, the South China Sea, Shunde, three water, wise five cities) various hospitals medicament branch and the related medical personnel fills. The issue time was in February, 1996, received the table time is in April, 1996. 2 results 2.1 take back 76 hospital medicament branch the statistical data, but can list separately according to the request the tumor branch medication has 37 hospitals. Has counted these 37 hospital tumor branch 1993-1995 year all previous years use stupefactive analgesic variety and the total quantity, discovered that the injection pai for ding is the application most main analgesic, next has the morphine injection, the codein tablet, the dihydro etorphine tablet, in 1995 also used the morphine to control releases the piece and Ding Bingnuo fei. Looking from the 3a medication total quantity, seemed to be increases year by year tendency, but is not too remarkable. 2.2 approach Foshan area 28 hospital related administrative offices provide questionnaire 210, reclamation answer paper 208, the effective volume is 206. because 3 discussions medical department, in implemented WHO to set “the goal” to take a series of effective measures, this city medicine policy department has also carried on the corresponding work, thus the majority of medical personnel (64.1%) have studied earnestly or have looked at “the guiding principle” generally; 94.7% people can apply drugs according to three steps and ladders for the cancer painful patient; 79.1% people thought that eases the pain thoroughly for the cancer painful patient has the necessity very much, because they saw personally some cancer painful patient is in deep sorrow, because some patients cannot obtain the enough medicine from the regular way, but purchases the heroin pain-relieving secretly. Thought that is not unnecessary is mainly worries the patient to become addicted to, either the patient could not withstand the medicine untoward effect or the worry drugs cannot guarantee the supply. The Foshan area most medical personnel's ideological concept had the preliminary transformation, but is also very insufficient. Looking from the narcotic 3a consumption, seemed to be advances year by year tendency, but the scope is not big. in 1995 had the hospital to use the new variety - morphine to control releases the piece. The existence question and suggested: (1) medical affairs, the medicament, the administrative personnel study “the guiding principle” not to be very also common and thorough, various aspects personnel have not reached the mutual recognition, if got the card patient to go to the pharmacy to take the medicine, the pharmacy did not coordinate, still according to old rule management. The suggestion further conducts has the study group which, the seminar various medical unit administrative personnel, the medical care personnel, the medicament personnel participate; (2) ideological concept thorough transformation, “has not become addicted to the phobophobia” still to fetter the general medical personnel's hands and feet. According to recently to dependent explanation [4], only then spiritual dependence, and has the compulsion to abuse is accompanied by endangers the society the doer only then to call becoming addicted. The becoming addicted to medication is for the pursue euphoria experience, but the cancer painful patient applies drugs the goal relieves the ache. Some investigation material indicated that in the long-term cancer pain treatment's patient, doubts has the becoming addicted to proportion not to 0.2%[5]. In our investigation material has 32% related medical personnel to see 1-6 examples because of the long-term use pai for the patient who ding becomes addicted to, but they refer to most is the tolerance which or the bodily dependence produces to the medicine, this is the normal Pharmacology which the application stupefactive analgesic appears inevitably continuously responded, so long as stops the medicine not suddenly, will not have the problem. Therefore we should “becomes addicted to from the fear” in the fetter liberate thoroughly, according to the clinical ache treatment's need, uses the stupefactive analgesic reasonably, moreover must strengthen the propaganda dynamics through each form, the transformation society public's idea; (3) investigation indicated that still injected to the specific weight ache pai for ding primarily, this and world developed country medication tendency exactly opposite [5]. pai for ding the major object is the response time short (2.5-3.5 h); Injection spot partial irritant; Its metabolite in vivo half-life is long, the redundant medication has to the central nervous system annoys the toxicity violently, may send the spirit exceptionally, to tremble and to faint from fright [6]; Adds again pai is obvious for ding the blood medicine density valley phenomenon, has the untoward effect reason. Therefore the WHO expert promotes with great effort use persistent effect oral administration preparation [4], recent years produced the morphine controlled releases the piece is the ideal variety, Greece organizes these drugs the supply; (4) suggestion "Narcotic Special-purpose Card" sends the card power to release from the sanitation bureau to the hospital medical affairs imposes the convenience cancer painful patient to receive; The suggestion changes a beforehand annual report narcotic plan one quarter to report one time, moreover does not remove temporary urgently needed; Also the suggestion in guaranteed that prevents the narcotic inflow society to become narcotic under the premise, simplifies the cancer painful patient to lead the medicine the procedure.
The cancer pain is the mid and late stage cancer patient universal existence question. At present according to the World Health Organization statistics, the cancer patient who the world occurs every year approximately has more than 700 ten thousand, 30%~50% are accompanied by the degree different ache. Our country recent investigation indicated that in the General hospital and in Specialized hospital's various issue of cancer patient, is accompanied by the varying degree ache to account for 51.1%. The ache is the cancer patient is most painful, endures most with difficulty one of symptoms, regardless of therefore doctor or the patients deal with it to have the clear understanding. Causes the cancer patient ache reason to be possible to divide into:①Ache which causes by cancer itself, if the tumor creates in partial either the shift spot infringement or the oppression nerve fiber ache, this is the most common reason.②Ache which causes by the treatment, after like surgery, scar constant pain, after chemotherapy stomatitis and so on.③Loses the ache which by the viability causes, like constipation, bedsore.④Ache which has nothing to do with cancer, like osteoarthritis, fascutis ache and so on. Because the ache is one kind of subjective sensation, thus the subjective factor (for example sensitivity, attention, mood, physical condition and so on) is affected in a big way. If the similar ache stimulation, is high in the sensitivity, the attention centralism, the fall in the blues and the bodily ordinary circumstances bad person causes the ache feeling is quite intense. You have possibly had such experience, when the centralism energy does an intense work either the activity (for example some kind of competition), the hand or the body are cut down the hemorrhage, but a feeling does not have, but others saw, tells you, only will then realize was injured. The cancerous ache's patient regular session related to doctor that the ache is evening heavier than the daytime. This is because the daytime will be engaged in each kind of activity, in addition the optical fiber, the sound stimulation, these can disperse the patient to the ache attention, but stopped the activity to the evening not having the light and the sound stimulation, the attention will also concentrate the ache spot, the ache will aggravate. Therefore has the cancerous ache patient, should understand fully these influencing factor, sets up defeats the indisposition the confidence, treats it by the strong will and the brave manner, and carries on some distractive the activity, like looked that the television, listens to the radio, to look the books and periodicals or recalled some meaningful matters, to a great extent will reduce the indisposition suffering.
(1) uses the pain-killer as far as possible early The control cancer pain's efficacious device is uses the analgetic medicine early, the prevention ache occurrence or prevents its aggravation. That is, if the ache appeared, do not wait till it becomes serious has treated again, but when just started, the use pain-relieving medicine control ache, like this obtains the effect is good, are also few with the dose. (2) not suitable pure dependent pain-killer The pure dependent pain-relieving medicine may not take. Because, each person is dissimilar to the pain-killer response. Not only this reflected that in the medicine variety, in the display drug efficacy's time, is the identical person uses the identical medicine, in the different time, the different environment produces the analgetic results to be also different. Must therefore pay attention to the flexibility in the pain-killer choice and the application method, and attempts to seek is suitable for own most effective analgetic method. While takes the analgetic medicine, may also apply the non-medicine pain-relieving method, like bodily relaxation therapy, distractive and so on. Not only this can enhance the analgetic effect, moreover causes the pain-killer to reduce with the dose, the working life lengthens, even cancels the medicine not to have the ache gradually.
The findings which according to the scientist at this week convenes the American Mind and body Association annual meeting which announces, in adult, if puts some sweet taste food on his/her tongue, can increase it to the ache tolerance. Studied for the doctorate in the McGill university Maxim D. Lewkowski to tell Reuter reporter saying:“the sweet taste liquid as if has the analgetic function.”Some research in before this once discovered that before gives an injection to the baby, gives them first oral administration sweet taste food, can reduce baby's making a tearful scene. Its reason possibly is causes the baby to ache better tolerance, but this kind of function in adult whether effective, are very actually few some people to study. In order to clarify this question, Lewkowski et al. investigated 72 young adults, lets them taste the sweet taste, the bitter taste solution or the clear water successively, then observes them to put in the hand the time length which in the ice water can endure. The result showed that when tastes the sweet taste liquid, it endures the time in the ice water to be longer, is 85 seconds equally, comparatively, when tastes the bitter taste liquid the mean time is 82 seconds, tastes when the clear water is 83 seconds. The researchers extrapolated that on tongue's sweet taste can promote the analgetic material function which to a certain extent in the human body produces naturally, these analgetic material is called the meconium class material or in fei the peptide. The researchers discovered that in blood pressure somewhat low trying, this kind of function is more remarkable. In a blood pressure somewhat low part trying, the sweet taste can make it to increase to the ache tolerance approximately 18%, but regarding these blood pressure high trying, the sweet taste does not have what function. Lewkowski said that this discovery showing or has hypertension regarding these hypertensions to favor trying, the sweet taste cannot play the alleviation ache the role. This possibly is because they produce naturally to the human body in the analgetic material reactivity reduces reason. The Lewkowski reminder said: “what is consistent with this extrapolation, hypertension's individual is bad to the analgetic material sensitivity.”
The clinical practice proved that prompt, uses the analgesic on time, not only may receive the good analgesic effect, moreover may choose the analgesia intensity low medicine, the use smallest dosage. When if the ache is fierce time uses the analgesic, the patient must suffer the ache suffering. If cannot obtain the analgesia treatment for a long time, because the cancer patient easy to have the ache to cause with the nerve pathological ache related nerve function disorder, displays for over sensitivity to pain and unusual ache and so on difficult the aches. Therefore, when not suitable the ache is fierce uses the analgesic. Can the part alleviation ache then On clinical, carries on the analgesia treatment to the cancer patient ache the goal eliminates the ache, improves cancer patient's quality of life. Let the cancer patient under not the painful condition the sleep, is eases the pain the treatment lowest standard to the cancer patient. The ideal analgesia treatment goal is lets the cancer patient rest, the activity under not the painful condition, the work. Cannot satisfy in the cancer patient ache part alleviates, must pursue the ache to eliminate completely. With pai for ding eases the pain is most effective, is safest Now did not advocate that pai for ding will use in cancer analgesia treatment, WHO pai for ding will not have listed as to cancer ache analgesia treatment medicine. The reason is:①pai for ding the analgesia function intensity is only the morphine 1/10~1/8.②pai for ding the analgesia duration is only the morphine 1/2~2/3.③pai for ding the metabolite to go to the armor pai for ding, to the central nervous system and the kidney virose function, its half-life is 3~18 hours. 4 pai are bad for ding the oral administration biology exploitability, must achieve the analgesic effect oral administration to the incremental dose, this time, goes to the armor pai for ding the quantity rises doubled and re-doubled.⑤Because pai is bad for ding the oral administration biology exploitability, uses the intramuscular injection to give the medicine, but the intramuscular injection itself will cause the ache. In brief, pai for ding is not suitable the patient who uses in the long-term ache. The meconium class medicine only suitably uses for the terminal cancer patient endures the quantity most greatly The clinical practice proved that the meconium class analgesic's amount used has the big individual difference, the minority cancer patient eases the pain the treatment to need the high dose. The pharmacology experiment prompts: The meconium class analgesic not places an upper limit on the effect. So long as the ache intensifies, may increase the meconium class medicine the amount used enhancement analgesia treatment effect. Regarding any specific weight ache patient, regardless of cancer clinical by stages sooner or later, estimate life length, so long as the analgesia treatment need, should use promptly endures the quantity meconium class analgesic most greatly, but cannot only to soon die the terminal cancer patient uses endures the quantity most greatly. The meconium class medicine presents the untoward effect to stop using The clinical practice proved that the meconium class medicine's untoward effect besides the constipation, majority is temporary, is also may endure. Therefore, as soon as sees the untoward effect to appear immediately stops the use meconium class medicine the method not being possible to take. Once the meconium class medicine uses is unable to stop using In medical practice, so long as the cancer patient ache cause of disease is under the control, the ache eliminates, momentarily may stop using the meconium class analgesic. When the morphine everyday use quantity is 30~60mg, will stop the medicine not to have the accident generally suddenly. The decrement will stop the medicine to the long-term massive medication's patient not to have the accident gradually. The decrement stops the medicine to make the law is specifically gradually: In initial two days decrement 25%~50%, every two day of decrements 25%, until the everyday use quantity are when thereafter 30~60mg stops the medicine. In the decrement process, whether there is should observe the cancer patient ache symptom gradually to appear. If has the ache symptom, and grades is bigger than 4, should further slow decrement, avoid stopping the medicine to have the ache symptom and the abstention too quickly breaks the symptom. The meconium class medicine cannot use in the lung cancer patient The practice proved that the meconium class medicine can use in the lung cancer patient ache effectively safely the treatment. Thought that the meconium class medicine cannot use in the lung cancer patient ache treatment the root lying in the meconium class contraceptive to have the side effect which the breath suppresses. In fact, lungs disease causes the scant of breath is circumference venereal diseases changes is the lungs pathological change result, but the meconium class medicine causes the breath suppresses is the side effect result which suppresses to the Respiratory center. The meconium class medicine itself does not aggravate the lungs pathological change. At the same time, the meconium class medicine the side effect which suppresses to the Respiratory center, generally only occurs when the medication excessive or the kidney function not all causes the medicine to store up. The meconium class medicine long-term use can have the energetic dependence In the clinical practice, the long-term use meconium class medicine, adopts the oral administration particularly or passes the skin way to give the medicine, the cancer patient presents the energetic dependence (formerly was called becomes addicted to) the risk extremely micro. Chinese Academy of Medical Sciences harmony Medical college Tumour hospital academician Sun Yan in the be more than 40 years cancer diagnoses in the process, only saw that 4 example patients have the energetic dependence. The average 10 years only then see one time. And, has carried out three steps and ladders pain-relieving therapy since 1990, an example had not seen. Overseas Porter reported that the use meconium class medicine presents the energetic dependent risk to be lower than extremely four (i.e. 4/11882). This explained sufficiently the cancer patient uses the meconium class medicine to cause the energetic dependence to be rare.
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