The best pain relief in oncology

• Three-stage pain correction system
• Types of painkillers
• How to relieve pain: a description of the stages of a three-step scheme
• How often does cancer pain occur?
• What is the reason for failure in pain treatment?
• Technologies for managing chronic pain syndromes
• Painkillers for stomach cancer
• Painkillers for lung cancer

Often the first and only symptom of cancer is pain. It causes suffering to the patient, reduces the quality of life, leads to depressive disorders, suicidal intentions and actions.

The fight against pain is a pressing problem in oncology. In order to effectively cope with pain, the doctor must correctly assess its causes, nature, and intensity.

At Euroonko, the area of ​​pain medicine is very well developed. Our doctors use all available methods, including innovative ones.

Three-stage pain correction system

The main method of treating pain in oncology is drug therapy. In the practice of Euroonko, a three-stage pain relief system of non-narcotic and narcotic analgesics is used, which allows you to effectively relieve pain and keep it under control. We take into account the recommendations of the World Institute of Pain (FIPP WIP, USA), the European Federation of the International Association for the Study of Pain (EF IASP).

The method consists of sequential use of analgesics of increasing strength in combination with adjuvant therapy as the pain intensity increases. An important principle is to begin pharmacotherapy immediately when the first signs of pain appear, before a complex chain reaction develops that leads to chronic pain syndrome. The transition to a stronger painkiller is made when all the drugs of the previous step are ineffective in their maximum dosages.

Types of painkillers

Pain relief begins with the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) in tablet form. These include Nurofen, Eferalgan, Nimesil, Diclofenac, etc. If they are ineffective, then at the second stage, combination drugs are prescribed to eliminate moderate pain. They include weak opiates and non-narcotic analgesics. Tramadol is most often prescribed from this group due to its effectiveness and ease of use. The third stage of pain therapy involves the prescription of narcotic analgesics, which help cope with even severe pain. These include buprenorphine, morphine, fentanyl, and omnopon.

Also, corticosteroids - preparations of adrenal hormones - are often used as analgesics. They have a powerful anti-inflammatory effect, especially important for pain caused by nerve compression, headaches caused by intracranial hypertension, and bone pain.

For each patient, medications are selected individually, so there is no universal scheme.

At any stage of pain therapy, analgesics must be taken regularly by the hour. The dose is adjusted taking into account the type and intensity of pain. If the drug becomes ineffective, it is advisable to replace it with an alternative drug of similar strength, but recommend it to the patient as more powerful.

Corticosteroids - preparations of adrenal hormones - are often used as analgesics. They have a powerful anti-inflammatory effect, especially important for pain caused by nerve compression, headaches caused by intracranial hypertension, and bone pain.

Anesthesiologist-resuscitator Vadim Sergeevich Soloviev about opioid analgesics:

Our doctors follow the principles of pain therapy proclaimed by WHO:

• “By mouth” (orally)
  means that all injectable forms of analgesics should be excluded and therapy should be carried out using non-invasive dosage forms (tablets, capsules, syrups, transdermal therapeutic systems, rectal forms of drugs, etc.).
• “On the clock”
  - analgesics should be prescribed regularly according to the schedule, in accordance with the duration of the drug’s effect, without waiting for the development of severe pain, excluding the possibility of “breakthroughs” of pain.
• “Ascending”
  - the selection of drugs for pain relief is carried out from non-opioid analgesics for mild pain, “mild” opioids for moderate pain and strong opioid analgesics for severe pain, as the pain intensity increases, in accordance with the “WHO pain management ladder”
• “Individual approach”
  - implies the need for an “individual” selection of an analgesic and is based on the selective selection of the most effective analgesic in the required dose with the least side effects for each individual patient, taking into account the characteristics of his physical condition.
• “With attention to detail”
  - involves taking into account the characteristics and details of each patient, of course, prescribing co-analgesics and adjuvant agents as the need arises, and monitoring patients.

How to choose painkillers

When searching for the right medication, always follow the prescription of your doctor. And then evaluate the options presented for sale on several indicators - purpose, intensity and nature of symptoms, composition, limitations and risks, effectiveness and reviews.

Purpose

For some pathologies and disorders, analgesics may be inappropriate. For example, if you suffer from pain during menstruation or intestinal colic in the abdomen, doctors recommend using antispasmodics.

If you need to relieve back pain, tablets are selected with a complex action, like NSAIDs, which not only suppress the symptoms, but also suppress inflammation. They are also prescribed for febrile diseases.

Acute syndrome requires, on the contrary, a quick-acting analgesic. For example, to relieve toothache, tablets for migraines and headaches, as well as for bruises and injuries. Here a mono-composition of a narrow focus is used.

Intensity and nature of pain

Be sure to consider the reasons why the alarming symptoms were caused. There are 2 sources:

• from external stimuli that excite nerve cells, after which the brain sends appropriate signals;
• due to damage or dysfunction of the nerves themselves, which requires not only symptomatic, but also complex treatment.

This leads to various methods of struggle aimed at eliminating the causes, inhibiting the sensitivity of receptors, stopping the pain signal, or changing the perception of the symptom by the brain.

Active substance

Based on their content, commercially available medications are divided into several groups:

• NSAIDs – non-steroidal anti-inflammatory drugs, where the active substances include ketoprofen, diclofenac, ibuprofen, nimesulide, etc.;
• anesthetics - work locally, stopping only the source of symptoms; lidocaine and benzocaine are used here;
• antipyretics – reduce high temperature during febrile conditions, contain metamizole, paracetamol;
• combined – mixed formulas where components from several of the above groups can be used.

Which of these to choose is determined by the doctor after an examination and tests to make a diagnosis.

Contraindications and side effects

You will have to “pay” for the pain-relieving effect. When an active substance inhibits cyclooxygenases, consequential effects may occur. The most common symptoms are stomach irritation and increased acidity. Less often, the wound healing process is disrupted, as are malfunctions of the kidneys and liver.

Efficiency and reviews

Before you buy anything, read the opinions of medical experts, publications about drugs on reputable sources, as well as the opinions of the patients themselves. This information will show how the promised results coincide with reality, what is the likelihood of developing side effects.

How to relieve pain: a description of the stages of a three-step scheme

Low pain therapy

The patient is prescribed non-opioid analgesics: NSAIDs (Ibuprofen, Diclofenac, Ketoprofen, etc.), Paracetamol. When choosing a drug, the toxicity to the liver and kidneys inherent in all non-opioid analgesics, as well as the gastric toxicity of non-selective NSAIDs, and the risks from the cardiovascular system when using selective NSAIDs are taken into account. It is advisable to accompany the use of first-line drugs with adjuvant and symptomatic therapy: ion pump blockers, corticosteroids, antispasmodics, benzodiazepines, antihistamines, etc.

Therapy for “moderate” pain

The oral route of drug administration is preferred if the patient can take the drugs by mouth. For patients with mild to moderate pain in whom adequate pain control is not achieved by regular oral paracetamol or non-steroidal anti-inflammatory drugs, the addition of an opioid analgesic may provide effective pain relief without adverse side effects. As an alternative, low-dose opioid analgesics (eg, morphine, TTC fentanyl) may be used.

Therapy for “severe” pain

If the pain is intense and an opioid analgesic in combination with NSAIDs or Paracetamol is ineffective, therapy with strong opioid analgesics should be started. If they were prescribed for moderate pain, you need to increase the dose of the drug until it is effective. Registered prolonged forms of strong opioid analgesics in our country and used in our clinic are: morphine in capsules and tablets, TTC fentanyl.

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Non-narcotic painkillers

The most popular drug Aspirin belongs to this group. It contains acetylsalicylic acid. In addition to relieving pain, it lowers temperature and thins the blood. Therefore, it should not be taken by persons with reduced blood clotting. It is also contraindicated for damage to the gastric and intestinal mucosa. The drug may cause bleeding.

It is also not given to children under fifteen years of age.

There are analogues of aspirin:

• Upsarin Upsa;
• Aspirin Cardio;
• Aspicor;
• Citramon;
• Thrombo-ass;
• Cardio-magnyl;
• Anopyrine.

Paracetamol is also included in the group of non-narcotic painkillers. It is the most harmless of the drugs in this group. It is even prescribed to pregnant women and children. But it should not be taken uncontrollably, because it has a negative effect on the liver.

There are analogues of Paracetamol:

• Panadol;
• Daleron;
• Solpadeine;
• Panadol Extra;
• Trigan-D;
• Coldrex;
• Sanidol;
• Perfalgan;
• Meksalen;
• Medipirin;
• Panadol active.

The most common painkiller is Ibuprofen. It effectively relieves pain, but is classified as an NSAID, so it should not be taken by patients with gastrointestinal ulcers or people with reduced blood clotting.

Ibuprofen analogues:

• Nurofen;
• Ibusan;
• Moment;
• Ibufen;
• Advil;
• Pedea;
• Burana;
• Ibuklin Junior.

Drotaverine is a well-known antispasmodic. It is even used during childbirth. Relieves various spasms. It is not prescribed to children under six years of age, or to nursing mothers. Otherwise the medicine is called No-shpa.

Ketarolac is the most powerful drug in this group. It is taken for severe toothaches and conditions after operations. Not prescribed to children under sixteen years of age, nursing mothers, or persons with kidney, heart, or stomach diseases.

Diclofenac is a non-steroidal anti-inflammatory drug. Relieves pain from arthrosis, arthritis, toothache.

Analogues:

• Voltaren;
• Ortofen;
• Dorosan;
• Orthoflex;
• Naklofen.

Oxycams relieve pain in joint diseases. Not prescribed for children, stomach ulcers, or kidney disease.

How often does cancer pain occur?

Pain occurs in 30% of cancer patients who receive treatment and in 60–90% of patients due to disease progression. The main sources of cancer pain:

• cancer itself (45–90%);
• concomitant inflammatory reactions leading to spasm of smooth muscles (11–25%);
• pain in the area of ​​the postoperative wound after surgery (5–16%);
• concomitant pathology, for example, joint damage, arthritis (6–11%), neuralgia (5–15%).

Cancer pain syndromes are grouped:

• According to the origin of the pain flow: visceral, somatic, neuropathic, psychogenic.
• According to qualitative subjective assessment: burning, stabbing, cutting, drilling, pulsating.
• By intensity: assessed using special scales.
• Duration: acute and chronic.
• By localization: abdominal, cardialgia, lumbodynia, muscle-articular and others.

Due to significant differences in the mechanisms of pain, there is no universal analgesic to relieve all types of pain syndromes. Treatment should always be individualized.

Get rid of pain

Painkillers and anti-inflammatory drugs

Pain is an integral part of our life. It is a kind of protective reaction that occurs in response to irritation of pain receptors, which are located in various organs and tissues. The appearance of pain indicates problems, serious diseases and pathological processes occurring latently in the body. It indicates what poses a threat to human health, helping to identify and eliminate the problem. Pain is an alarming signal that should never be ignored.

However, pain has not only positive, but also negative qualities. Whatever painful sensations a person experiences: nagging, sharp, pulsating or dull, they unsettle him, disrupting his usual way of life. Each of us, having barely felt the pain, strives to eliminate it as quickly as possible. But how to do that? How to remove pain of varying nature and intensity? Unfortunately, it is extremely difficult to cope with these unpleasant sensations on your own and, perhaps, only masters of self-control and yoga can do it. Other people have to resort to painkillers. Painkillers or analgesics are medications that relieve pain. Depending on the main active ingredient present in their composition and the form of release, they can affect the peripheral nervous system, brain, or have a local analgesic effect.

Very important! Painkillers do not cure! You've probably already heard that painkillers only eliminate pain without affecting the cause of the pain. In other words, with the help of analgesics you can only temporarily get rid of unpleasant sensations. A disease or other pathological process in the absence of proper drug treatment will continue to progress, exacerbating attacks of pain. Therefore, it is very important to immediately consult a doctor if you have persistent and severe pain of any origin!

Today, medicine offers a wide range of painkillers, presented in the form of ointment, powder, gel, drops, tablets and injection solution. You should choose an anesthetic based on the location of the pain and the cause that caused it. Let's look at an example. You hurt your arm and are now suffering from severe and excruciating pain. In order to eliminate pain in this situation, you need to use analgesics presented in the form of an ointment or gel (Finalgon, Lyoton, Nise-gel, etc.), since the cause of pain is local damage to the tissues and skin. If the pain does not disappear within 2–3 days, be sure to consult a doctor.

Based on their chemical nature and pharmacological properties, painkillers are divided into two main groups: non-narcotic and narcotic drugs.

Non-narcotic painkillers . They are analgesic drugs that do not have a significant effect on the central nervous system. This group of analgesics does not have a hypnotic or sedative effect and is not addictive. They are also called non-steroidal anti-inflammatory drugs because, in addition to their main action, they also help eliminate inflammatory processes. The most prominent representatives of this group of analgesic drugs include Analgin, Paracetamol, Ibuprofen, Voltaren, Naproxen, etc.

Narcotic pain pills . Narcotic analgesics are pain-relieving drugs whose principle of action is to inhibit the central nervous system. At the same time, other types of sensitivity remain at the same level: temperature, tactile, etc. This group of analgesic medications affects certain parts of the central nervous system, changing the “character” of pain. The complex effect of drugs on the centers of the cerebral cortex contributes to the development of a state of bliss and euphoria. With prolonged use of such medications, a person develops drug dependence.

As a rule, these medications are prescribed to reduce pain that occurs against the background of such serious diseases as myocardial infarction, malignant tumors, etc. Among the representatives of this group of drugs are Alfentanil, Buprenorphine, Butorphanol, Morphine and other drugs.

Recently, medications have been widely used that eliminate pain, but do not belong to the group of analgesics. We are talking about antispasmodics - medications that eliminate attacks of spastic pain. Such painful manifestations are the result of spasms of the smooth muscles of internal organs: the gastrointestinal tract, biliary system, and urinary tract. They often occur against the background of poor nutrition, chronic diseases of the gastrointestinal tract and other similar phenomena.

Taking antispasmodics in such situations is most effective when compared with conventional analgesics, since in order to eliminate pain it is necessary to first eliminate spasms of the smooth muscles of the internal organs. Medicines that relax smooth muscles include No-Shpa, Atropine, Papaverine, Buscopan, Spasmol, Drotaverine, etc.

What is the reason for failure in pain treatment?

Due to the lack of specialized training in pain management, even among oncologists, and due to the perception of cancer as an incurable disease, even medical specialists often do not realize that cancer pain can be managed.

In 80–90% of patients, pain can be completely eliminated, and in the rest, its intensity can be significantly reduced. To do this, the doctor needs to take into account each of the sources and mechanisms of pain to select adequate pain therapy for cancer.

In clinical practice, we constantly encounter typical errors in the treatment of pain: unreasonably early prescription of narcotic analgesics, use of excessive dosages of drugs, non-compliance with the prescription regimen of analgesics.

Technologies for managing chronic pain syndromes

Euroonko is equipped with all the necessary equipment, including individual wearable pumps and devices for dosed administration. The clinic has the licenses and permits required by the legislation of the Russian Federation. We have a well-equipped pain therapy department staffed by physicians who specialize in pain medicine.

Use the quick links to find out about the pain relief method you are interested in:

• Pain relieving patches
• Spinal anesthesia
• Epidural anesthesia
• Catheterization techniques
• Neurolysis through the gastrointestinal tract using endosonography
• Injection of drugs into myofascial trigger points
• Fascial blocks and nerve and plexus blocks
• Radiofrequency ablation
• Neurosurgical interventions
• Patient controlled analgesia (PCA)

Pain relief for stage 4 cancer can significantly improve the patient’s quality of life, reduce, and in most cases prevent suffering. This helps to give the terminally ill patient additional time during which he can actively communicate with family and friends and spend the last days of his life without painful symptoms.

Pain relieving patches

This is a method of transdermal administration of the drug. The patch contains four layers: a protective polyester film, a reservoir with the active substance (for example, fentanyl), a membrane that adjusts the release intensity and an adhesive layer. The patch can be applied anywhere. Fentanyl is released gradually over 3 days. The effect begins within 12 hours; after removal, the concentration of the drug in the blood slowly decreases. The dosage may be different, it is selected individually. The patch is prescribed, as a rule, at the very beginning of the third stage of pain relief for oncology.

Spinal anesthesia

During spinal anesthesia, the medicine is injected into the spinal canal, subarachnoidally. This leads to a temporary “switching off” of tactile and pain sensitivity. The introduction requires a certain amount of experience from the doctor. Local anesthetics and opioid analgesics are used as pain relievers. The effect is long lasting and pronounced. Mainly used for surgical interventions, for acute, unbearable pain, it has a number of side effects on the cardiovascular and respiratory systems.

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Epidural anesthesia

A more gentle method compared to the previous one. The medicine is injected into the space where the spinal nerves form. The drugs are similar to spinal anesthesia. Epidural anesthesia is used for long-term pain relief when oral and parenteral methods of administration no longer provide results.

Catheterization techniques

Catheterization techniques allow for long-term, high-quality pain relief. The introduction of port systems into the epidural and subarachnoid space with the use of local, narcotic and adjuvant drugs allows for long-term relief from pain and reduces the use of other analgesics that have their own side effects.

Neurolysis through the gastrointestinal tract using endosonography

Neurolysis (neurolysis) is the process of destruction of the nociceptive (pain) nerve pathway.

One of the most effective methods is neurolysis of the celiac (solar) plexus

, which is located in the retroperitoneal space in the upper abdomen and innervates the abdominal organs: stomach, liver, biliary tract, pancreas, spleen, kidneys, adrenal glands, large and small intestines to the splenic flexure.

The analgesic is administered transgastrically - through the gastrointestinal tract; accuracy is ensured by endoscopic ultrasound control. Such methods of local anesthesia are used, for example, for pancreatic cancer with an effectiveness of up to 90%

. The analgesic effect can last for more than several months, while narcotic analgesics would have to be administered continuously using the classical method.

Injection of drugs into myofascial trigger points

Myofascial pain syndrome is expressed in muscle spasm and the appearance of painful lumps in tense muscles. These are called trigger points and are painful when pressed. Injections into the trigger zone relieve pain and improve mobility of the body area. The purpose of trigger point injections is to “break” the pain cycle of pain-spasm-pain. They successfully treat spasms of many muscle groups, especially in the arms, legs, lumbar region and neck, and head. Often used as adjunctive therapy for fibromyalgia and tension headaches.

Fascial blocks and nerve and plexus blocks

The same qualitative effect is provided by fascial blockades and blockades of nerves and plexuses.

A nerve or plexus block involves injecting a drug near the nerve that connects to the affected organ and causes pain. Peripheral blockade procedures are performed by experienced specialists using ultrasound navigation, which allows for more precise administration of the analgesic drug to the required location without affecting or damaging the nerve structures.

The use of hormonal drugs during blockade can eliminate pain for a long time, and repeated blockade can eliminate pain for several months

. Depending on the type of anesthetic, the procedure is carried out once a year, once every six months or every week. Another plus is the minimal number of negative consequences.

Radiofrequency ablation

This technology is based on selective thermocoagulation of certain nerves with special electrodes. The affected area is carefully controlled, allowing very small areas to be treated without damaging nearby motor and sensory nerves. Recovery after the procedure occurs very quickly and with almost no consequences, which allows the patient to return to normal life.

The procedure can be performed without hospitalization. Radiofrequency destruction gives a long-lasting effect that can last up to a year or more

.

The incidence of complications and side effects is very low. If the pain returns, treatment may be repeated.

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Patients with obvious mental disorders, with secondary pain or drug addiction are an unsuitable population for neurodestructive manipulations. Such patients may continue to complain of pain even if the procedure is successful. The patient must have a realistic view of the outcome of treatment. He must understand that the goal is to reduce pain, not completely eliminate it.

a diagnostic blockade is required.

. A good effect of a diagnostic blockade can predict a satisfactory result of neurodestruction. However, the same diagnostic block must be repeated at least one more time, even if the pain relief was significant, to negate the placebo effect.

If the result is not entirely clear, differential blocking should be used. In patients with widespread or multilocal pain, the outcome of treatment usually does not meet expectations. The patient should be aware that targeting one area may not achieve the desired effect and may require additional destruction to achieve maximum pain relief.

Euroonco doctors talk about radiofrequency ablation:

The procedure should be avoided on mixed nerves as it may result in loss of skin sensation and muscle weakness. Deafferentation pain can be aggravated by destruction of the damaged nerve. When pain is of central origin (spinal or higher), peripheral nerve destruction may cause an increase in pain perception due to the elimination of incoming stimulus. The best alternative in this case is neuroaugmentation with TENS or spinal cord stimulation.

Neurosurgical interventions

During the procedure, the neurosurgeon cuts the spinal or cranial nerve roots through which the nerve fibers pass. Thus, the brain is deprived of the ability to receive pain signals. Cutting the roots does not lead to loss of motor ability, but may complicate it.

Patient controlled analgesia (PCA)

This type of pain relief is based on a simple rule: the patient receives analgesics when he wants it. The scheme is based on individual perception of pain and the need to take analgesics. In European countries, RSA has been accepted as the standard for postoperative pain management. The method is simple and relatively safe

. However, patients must be thoroughly instructed.

PCA is most effective when using catheter methods (epidural, spinal anesthesia, nerve plexus block with catheter installation), as well as port systems, both venous and epidural and intrathecal.

Mechanism of action of painkillers

When tissue damage or inflammation occurs, a signal travels along the nerve endings to the brain. In the damaged area, irritation of the nerve endings occurs. As a result of muscle contraction, a spasm occurs.

Painkillers act as follows:

• inhibit nerve impulses that transmit pain;
• soothe irritated nerve endings;
• relieve muscle spasms.

Depending on the type of pain, painkillers are used.

Painkillers for stomach cancer

About 70% of patients suffering from stomach cancer experience discomfort and pain. As a rule, pain is localized in the abdomen, but as the tumor progresses it can also occur in other places: in the back, ribs, bones. Neuropathic pain may occur as a symptom of paraneoplastic syndrome or a side effect of chemotherapy.

In addition to the three-step system, benzodiazepines, antidepressants, adrenal hormones (prednisolone, dexamethasone), sleeping pills, and antipsychotics are used to combat pain and discomfort in stomach cancer. For bone pain and pathological fractures, bisphosphonates are prescribed.

The doctor can perform two types of nerve blocks:

1. Celiac plexus block
   helps relieve pain in the upper abdomen. The conduction of pain impulses through the nerves of the stomach, liver, pancreas, gall bladder, intestines, and kidneys is blocked.
2. Hypogastric plexus block
   helps relieve pain in the lower abdomen. During it, the nerves of the lower intestine, bladder, testicles, penis, prostate, uterus, ovaries, and vagina are blocked.

Plexus blocks can be performed using anesthetics and drugs that temporarily damage the nerves. With neurolysis, a drug is administered that destroys the plexus.

Painkillers for lung cancer

The cause of chest pain due to lung cancer can be the tumor itself or a surgical procedure. Other possible reasons:

• Metastases in the brain lead to headaches.
• Metastases of the abdominal organs lead to abdominal pain.
• Metastases in the bones lead to bone pain and pathological fractures.
• Paraneoplastic syndrome leads to neuropathic pain in different parts of the body.
• Pain is one of the side effects of chemotherapy.

In addition to pain-relieving injections for lung cancer with NSAIDs and narcotic analgesics, other drugs, nerve blocks, radiation therapy, and palliative surgical interventions help.

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