Pain in oncology


 * Pain is one of the most common symptoms that accompanies cancer.
 * In a quarter to a half of patients, pain is the first symptom.

Etiology of cancer pain

 * Direct tumor invasion (70%) - skeletal involvement, invasion or compression of nerve structures, obstruction of hollow organs or outlets, invasion of blood vessels or obstruction of blood vessels, ulceration, mucosal infiltration.
 * In connection with treatment (20%) - diagnostic and staging examinations, postoperative pain, radiation pain (stomatitis, esophagitis, spinal cord injury), after chemotherapy (neuropathic, stomatitis, hemorrhagic cystitis, ...).
 * In a more distant context (below 10%) - paraneoplastic pain (hypertrophic osteoarthropathy), pain associated with low performance and self-sufficiency (bedsores, constipation), ...
 * Tumor Esophagus2.JPG of non-tumor origin (10%).

Examination of pain

 * We determine the location, character, propagation, and changes in intensity over time.
 * Intensity:
 * visually analog curve - a line 10 cm long, its left end indicates "no pain" and the right "worst imaginable pain", the patient marks the value on the curve that corresponds to his pain;
 * Melzack scale - the patient classifies pain as mild, uncomfortable, strong, cruel, unbearable.

Pain treatment

 * The procedure varies according to the type and intensity.
 * In the first place, it is necessary to treat the cause of the pain.
 * Palliation leads to a reduction in analgesic consumption in many tumors (we gain temporary control over the tumor).
 * We achieve symptomatic relief in 80% orally, in 10% the intervention of an anesthesiologist or surgeon is necessary, in about 10% it is not possible to achieve optimal relief.
 * The optimal pain relief is a reduction in the intensity of approximately 90%.
 * Analgetika.jpgete removal is usually only possible at the cost of significant patient sedation.

Treatment scheme

 * First grade - NSAIDs (Non-steroidal anti-inflammatory drugs) and analgesics-antipyretics.
 * Second grade - weak opiates (codeine, dihydrocodeine, propoxyphene, oxycodone, tramadol).
 * Third grade - strong opiates (morphine, fentanyl, buprenorphine).
 * Anticonvulsants and muscle relaxants are effective in neuropathic pain.
 * Neuroleptics increase the pain threshold.
 * Antidepressants eliminate painful psychosyndrome, fear, paraesthesia, improve sleep.
 * The combination of opiates and NSAIDs has an additive effect.
 * The antiedematous effect of corticoids, also bisphosphonates, is used for bone metastases.
 * Analgesics are given at fixed intervals, the next dose is given before the effects of the previous one subside.
 * We preferably use p.o. treatment.
 * External analgesic radiation can also be used for bone metastases, and brain meta can also be affected.
 * Use of 89Sr (strontium) - useful in multiple skeletal metastases, in functional marrow (the main emergency is thrombocytopenia).
 * Pharmacologically uncontrollable pain - epidural or subarachnoid anesthesia, neurolysis, or neurosurgery.