Types and methods of pain relief in cancer: general and local anesthesia in oncology. Cancer treatment: the search for new drugs continues

Pain is one of the key symptoms of cancer. Its appearance indicates the presence of cancer, its progression, secondary tumor lesions. Anesthesia in oncology is the most important component of the complex treatment of a malignant tumor, which is designed not only to save the patient from suffering, but also to keep his vital activity as long as possible.

Every year, up to 7 million people die from cancer in the world,with this, the pain syndrome worries about a third of patients in the first stages of the disease and almost everyone in advanced cases. It is extremely difficult to deal with such pain for a number of reasons, however, even those patients whose days are numbered, and the prognosis is extremely disappointing, need adequate and proper anesthesia.

Painful sensations bring not only physical suffering, but also violate the psycho-emotional sphere. In cancer patients on the background pain syndrome depression develops, suicidal thoughts appear and even attempts to die. At the present stage of development of medicine, such a phenomenon is unacceptable, because in the arsenal of oncologists there are a lot of drugs, the correct and timely administration of which in adequate doses can eliminate pain and significantly improve the quality of life, bringing it closer to that of other people.

The difficulties of anesthesia in oncology are associated with a number of reasons:

• Pain is difficult to assess correctly, and some patients themselves cannot localize it or describe it correctly;
• Pain is a subjective concept, therefore its strength does not always correspond to what the patient describes - someone downplays it, others exaggerate it;
• Refusal of patients from anesthesia;
• Narcotic analgesics may not be available in sufficient quantities;
• The lack of special knowledge and a clear scheme for prescribing analgesics by oncology clinic doctors, as well as neglect of the prescribed patient regimen.

Patients with oncological processes are a special category of people, to whom the approach should be individual. It is important for the doctor to find out exactly where the pain comes from and the degree of its intensity, but due to different pain threshold and subjective perception of negative symptoms, patients of the same pain can be regarded differently in terms of strength.

According to current data, 9 out of 10 patients can completely get rid of pain or significantly reduce it with a well-chosen analgesic regimen, but for this, the doctor must correctly determine its source and strength. In practice, things often happen differently: obviously stronger drugs are prescribed than necessary at this stage of the pathology, patients do not comply with the hourly regimen of their intake and dosage.

Causes and mechanism of pain in cancer

Everyone knows that main factor when pain appears, it is a growing tumor itself, but there are other reasons that provoke and intensify it. Knowledge of the mechanisms of the pain syndrome is important for the doctor in the process of choosing a specific therapeutic regimen.

Pain in a cancer patient may be due to:

1. Actually a cancerous tumor that destroys tissues and organs;
2. Concomitant inflammation, provoking muscle spasm;
3. The operation performed (in the area of ​​remote education);
4. Concomitant pathology (arthritis, neuritis, neuralgia).

According to the degree of severity, weak, moderate, intense pains are distinguished, which the patient can describe as stabbing, burning, throbbing. In addition, the pain can be both intermittent and permanent. In the latter case, the risk of depressive disorders and the patient's desire to end his life is highest, while he really needs strength to fight the disease.

It is important to note that pain in oncology can have a different origin:

Given this versatility of the pain syndrome, it is easy to explain the lack of a universal pain reliever. When prescribing therapy, the doctor must take into account all possible pathogenetic mechanisms of the disorder, and the treatment regimen can combine not only medication support, but also the help of a psychotherapist or psychologist.

Scheme of pain therapy in oncology

To date, the most effective and appropriate is recognized as a three-stage scheme for the treatment of pain, in which the transition to the next group of drugs is possible only if the previous one is ineffective at maximum dosages. Such a scheme was proposed by the World Health Organization in 1988, is used everywhere and is equally effective in lung, stomach, breast cancer, soft tissue or bone sarcomas, and many other malignant neoplasms.

Treatment of progressive pain begins with non-narcotic analgesics., gradually increasing their dose, then they switch to weak and potent opiates according to the scheme:

1. Non-narcotic analgesic (non-steroidal anti-inflammatory drug - NSAID) with adjuvant therapy (mild to moderate pain).
2. Non-narcotic analgesic, mild opiate + adjuvant therapy (moderate to severe pain).
3. Non-narcotic analgesics, a strong opioid, adjuvant therapy (with constant and severe pain in stage 3-4 cancer).

If the described sequence of anesthesia is followed, the effect can be achieved in 90% of cancer patients, while mild and moderate pain disappears completely without prescribing narcotic drugs, and severe pain is eliminated with opioid narcotic drugs.

adjuvant therapy is the use of drugs with their own useful properties- antidepressants (imipramine), corticosteroid hormones, anti-nausea drugs and other symptomatic drugs. They are prescribed according to indications individual groups patients: antidepressants and anticonvulsants for depression, neuropathic pain mechanism, and for intracranial hypertension, bone pain, compression of nerves and spinal roots by a neoplastic process - dexamethasone, prednisolone.

Glucocorticosteroids have a strong anti-inflammatory effect. In addition, they increase appetite and improve the emotional background and activity, which is extremely important for cancer patients, and can be prescribed in parallel with analgesics. The use of antidepressants, anticonvulsants, hormones allows in many cases to reduce the dose of analgesics.

When prescribing treatment, the doctor must strictly observe its basic principles:

The patient is informed that the prescribed treatment should be taken by the hour and in accordance with the multiplicity and dose indicated by the oncologist. If the drug stops working, then it is first changed to an analogue from the same group, and if it is ineffective, they switch to stronger analgesics. This approach avoids an unreasonably rapid transition to strong drugs, after the start of therapy with which it will no longer be possible to return to weaker ones.

The most common mistakes that lead to the ineffectiveness of the recognized treatment regimen are considered to be an unreasonably quick transition to stronger drugs, when the possibilities of the previous group have not yet been exhausted, prescribing too high doses, which makes the likelihood of side effects increase dramatically, while the pain is not stopped, and also non-compliance with the treatment regimen with skipping doses or increasing the intervals between doses of drugs.

I stage of analgesia

When pain occurs, they are first prescribed non-narcotic analgesics- non-steroidal anti-inflammatory, antipyretic:

1. Paracetamol;
2. Aspirin;
3. ibuprofen, naproxen;
4. Indomethacin, diclofenac;
5. Piroxicam, movalis.

These agents block the production of prostaglandins that cause pain. A feature of their action is considered to be the termination of the effect upon reaching the maximum allowable dose, they are prescribed independently for mild pain, and for moderate and severe pain syndrome - in combination with narcotic drugs. Anti-inflammatory drugs are especially effective in case of tumor metastasis to the bone tissue.

NSAIDs can be taken in the form of tablets, powders, suspensions, and injections in the form of painkillers. The route of administration is determined by the attending physician. Considering the negative effect of NSAIDs on the mucosa of the digestive tract during enteral use, patients with gastritis, peptic ulcer, for people over 65 years of age, it is advisable to use them under the cover of misoprostol or omeprazole.

The drugs described are sold in a pharmacy without a prescription, but you should not prescribe and take them yourself, without the advice of a doctor, due to possible side effects. In addition, with self-treatment, the strict analgesia regimen changes, medication can become uncontrolled, and in the future this will lead to a significant decrease in the effectiveness of therapy in general.

As monotherapy, pain treatment can be started with analgin, paracetamol, aspirin, piroxicam, meloxicam, etc. Combinations are possible - ibuprofen + naproxen + ketorolac or diclofenac + etodolac. Given the likely adverse reactions, it is better to use them after meals, drinking milk.

Injection treatment is also possible, especially if there are contraindications to oral administration or a decrease in the effectiveness of tablets. So, analgesic injections may contain a mixture of analgin with diphenhydramine for mild pain, with insufficient effect, the antispasmodic papaverine is added, which is replaced by ketane in smokers.

Strengthening the effect can also give the addition of analgin and diphenhydramine ketorol. Bone pain is best eliminated by such NSAIDs as meloxicam, piroxicam, xefocam. Seduxen, tranquilizers, motilium, cerucal can be used as adjuvant treatment at the 1st stage of treatment.

II stage of treatment

When the effect of pain relief is not achieved by the maximum doses of the drugs described above, the oncologist decides to move on to the second stage of treatment. At this stage p progressive pain is relieved by weak opioid analgesics - tramadol, codeine, promedol.

The most popular drug is tramadol due to ease of use, because it is available in tablets, capsules, suppositories, oral solution. It is characterized by good tolerance and relative safety even with prolonged use.

It is possible to prescribe combined drugs, which include non-narcotic painkillers (aspirin) and narcotic (codeine, oxycodone), but they have a final effective dose, upon reaching which further administration is inappropriate. Tramadol, like codeine, can be supplemented with anti-inflammatory agents (paracetamol, indomethacin).

Painkillers for cancer in the second stage of treatment are taken every 4-6 hours, depending on the intensity of the pain syndrome and the time that the drug acts in a particular patient. It is unacceptable to change the frequency of taking medications and their dosage.

Pain injections in the second stage may contain tramadol and diphenhydramine (at the same time), tramadol and seduxen (in different syringes) under strict control of blood pressure.

III stage

A strong pain reliever for oncology is indicated in advanced cases of the disease (stage 4 cancer) and with the ineffectiveness of the first two steps of the analgesic regimen. The third stage includes the use of narcotic opioid drugs - morphine, fentanyl, buprenorphine, omnopon. These are centrally acting drugs that suppress the transmission of pain signals from the brain.

Narcotic analgesics have side effects, the most significant of which is addiction and a gradual weakening of the effect, requiring an increase in dose, so the need to move to the third stage is decided by a consultation of specialists. Only when it becomes known for sure that tramadol and other weaker opiates no longer work, the prescription of morphine is justified.

The preferred route of administration is by mouth, subcutaneously, into a vein, in the form of a patch. It is highly undesirable to use them in the muscle, since in this case the patient will experience severe pain from the injection itself, and active substance will be absorbed unevenly.

Narcotic painkillers can disrupt the functioning of the lungs, heart, and lead to hypotension, therefore, with their constant use, it is advisable to keep an antidote in the home medicine cabinet - naloxone, which, with the development of adverse reactions, will quickly help the patient return to normal.

One of the most prescribed drugs has long been morphine, the duration of the analgesic effect of which reaches 12 hours. The initial dose of 30 mg with an increase in pain and a decrease in efficiency is increased to 60, administering the drug twice a day. If the patient received painkillers injections and switches to oral treatment, then the amount of medication increases.

Buprenorphine- another narcotic analgesic that has less pronounced side effects than morphine. When applied under the tongue, the effect begins after a quarter of an hour and becomes maximum after 35 minutes. Buprenorphine lasts up to 8 hours, but you need to take it every 4-6 hours. When starting therapy with the drug, the oncologist will recommend bed rest for the first hour after taking a single dose of the drug. When taken in excess of the maximum daily dose at 3 mg, the effect of buprenorphine does not increase, which is always warned by the attending physician.

With constant pain of high intensity, the patient takes analgesics according to the prescribed scheme, without changing the dosage on his own and skipping the next medication. However, it happens that against the background of the treatment, the pain suddenly increases, and then active funds - fentanyl.

Fentanyl has several benefits:

• Speed ​​of action;
• Strong analgesic effect;
• Increasing the dose also increases efficiency, there is no "ceiling" of action.

Fentanyl can be injected or used as part of a patch. The analgesic patch works for 3 days, when fentanyl is slowly released and enters the bloodstream. The effect of the drug begins after 12 hours, but if the patch is not enough, then additional intravenous administration until the patch effect is achieved. The dosage of fentanyl in the patch is selected individually based on the treatment already prescribed, but older cancer patients require less than younger patients.

The use of the patch is usually indicated in the third step of the analgesic regimen, and especially in violation of swallowing or problems with the veins. Some patients prefer the patch as a more convenient way to take the medication. Fentanyl has side effects, including constipation, nausea, vomiting, however, when using morphine, they are more pronounced.

In the process of dealing with pain, specialists can use a variety of ways to administer drugs, in addition to the usual intravenous and oral ones - blockade of nerves with anesthetics, conduction anesthesia of the neoplasia growth zone (on the limbs, pelvic structures, spine), epidural anesthesia with the installation of a permanent catheter, injection of drugs into myofascial intervals, neurosurgical operations.

Anesthesia at home is subject to the same requirements as in the clinic, but it is important to ensure constant monitoring of treatment and correction of doses and names of drugs. In other words, you can’t self-medicate at home, but you should strictly follow the oncologist’s prescriptions and make sure that the medicine is taken at the set time.

Folk remedies, although very popular, are still not able to stop the severe pain associated with tumors, although there are many prescriptions for acid treatment, fasting, and even poisonous herbs on the Internet, which is unacceptable for cancer. It is better for patients to trust their doctor and recognize the need drug treatment without wasting time and resources on a deliberately ineffective fight against pain.

Video: Report on the circulation of painkillers in the Russian Federation

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

The international project Repurposing Drugs in Oncology (ReDO) found a significant anti-cancer effect in the well-known analgesic and anti-inflammatory drug diclofenac. The results of the work are published in ecancermedical science.

Diclofenac belongs to non-steroidal anti-inflammatory drugs (NSAIDs), which have long interested scientists as potential means of preventing cancer. It turned out that diclofenac can be used in the treatment of already developed tumors.

ReDO staff conducted a meta-analysis of works on the antitumor effect of diclofenac and concluded that this effect can be considered undoubted. Due to the well-studied pharmacokinetics, relatively low toxicity and low cost of the drug, scientists have classified it as a strong candidate for use as a chemotherapy agent.

The first study of the anticancer properties of the drug in an animal model dates back to 1983, when it was tested on rats with implanted fibrosarcoma - a slowdown in tumor growth was recorded. More recent animal and human cell culture studies have shown that diclofenac can inhibit cancer cell division in colon and rectal cancer, neuroblastoma, ovarian cancer, glioma, pancreatic cancer, melanoma, and prostate cancer.

Since diclofenac is used for pain relief in oncological diseases and after operations for them, there have been several retrospective studies comparing the results of treatment of patients treated with and not treated with diclofenac. It turned out that the administration of the drug statistically significantly reduced the likelihood of distant metastasis and overall mortality in patients with tumors of the breast, lung and kidney; sharply reduced the concentration of CA 19-9 (a biomarker of pancreatic adenocarcinoma) in the blood and slowed down the progression of the disease, and also significantly reduced the size of neoplasms in aggressive fibromatosis.

According to scientists, the antitumor effects of diclofenac are diverse. First of all, they are associated with its direct action as an inhibitor of cyclooxygenase (COX), in particular its second type. This enzyme synthesizes prostaglandins. One of them, prostaglandin E2, is found in a variety of neoplasms, where it maintains chronic inflammation by forming the tumor microenvironment. The effect of different NSAIDs on COX-2 varies greatly, and diclofenac binds to it especially well.

In addition, the antitumor activity of diclofenac may be responsible for its effects such as suppression of the growth of tumor-feeding vessels, immunomodulation, stimulation of apoptosis (natural cell death that is disturbed in cancer), suppression of platelet activity and glucose metabolism, as well as an increase in the sensitivity of cancer cells to radiation and chemotherapy. .

The collected data have aroused serious scientific interest in the anticancer properties of diclofenac, and four clinical trials are currently underway for this indication, with one of them already in phase IIB (in which the effectiveness of the drug at a given dose is being investigated).

ReDO is an international project designed to find anti-cancer properties in drugs that are or have been used for other indications. Preference is given to drugs that are widely available and inexpensive.

Diclofenac is a "classic" analgesic and anti-inflammatory drug developed and brought to market in 1973 by Ciba-Geigy, now part of Novartis. It is widely used for various pains, rheumatoid diseases, lesions of the musculoskeletal system and keratoses. Available in tablets, suppositories, injections, ointments and eye drops, in a number of countries it is available without a prescription.

Both acute and chronic types of pain require medical care. Chronic pain syndrome in oncological diseases has its own characteristics:

• It can develop in a short time (due to compression of the nerve trunks by a growing tumor or rapid massive destruction of the organ).
• May exist almost permanently due to overstimulation nervous system.
• It can persist even after the elimination of its source (due to breakdowns in the system of inhibition of nerve impulses).

Therefore, even at the stage of the absence of any sensations, but the existing proven diagnosis of a malignant neoplasm, a tactic of phased anesthesia should be developed - from weak to strong drugs.

By the time the pain appears or begins to intensify, the doctor and the patient should be armed with a ready-made strategy that can be applied specifically to this cancer patient, observing the necessary timing for increasing drug dosages or enhancing the analgesic effect.

Cancer Pain Assessment

The level of pain can only be adequately assessed by the one who experiences it. In addition, patients experience different sensations: drilling, cutting, tingling, pulsation, burning, etc. In order for these experiences to be better understood by the doctor, they use a visual scale of pain levels (see Fig.).

Pain scale from 0 to 10

According to the origin of pain in oncology, there are:

• Visceral pain. With neoplasms in abdominal cavity. Sensations of squeezing, fullness, pain aching or dull, not having a clear localization.
• Somatic pain. Develop in vessels, joints, bones, nerves. Continuous, dull pain.
• neuropathic pain. Occur when the nervous system is damaged: central and peripheral.
• Psychogenic pain. They appear against the background of depression, fear, self-hypnosis, without any organic damage, as a rule, painkillers do not help here.

What to do?

If the oncology is confirmed histologically, there is a diagnosis and the patient is observed by an oncologist:

• at the inpatient stage, the department in which the person is operated on or treated is responsible for anesthesia,
• if the patient is observed by a therapist in the clinic, and in the oncology clinic by an oncologist or transferred for observation to the doctor of the antitumor office of the clinic, he should, along with all the extracts and medical records, contact an analgist (most often in an oncology clinic). This should be done even if there is no pain. The analgist paints a step-by-step scheme of anesthesia, which the doctor observing the patient will adhere to.

If the cancer has not yet been confirmed - there is no diagnosis confirmed by histology, but there is pain - it is also worth contacting an analgist and getting recommendations fixed in writing in the medical documentation (entry in the outpatient card, extract).

• If you have not yet been treated to an analgist, but there is pain, contact your local therapist. It is in his power to prescribe non-narcotic analgesics and concomitant drugs that relieve or relieve pain.
• If non-narcotic analgesics were previously used, but their effect is not enough, you should immediately get the recommendations of the analgologist, with which they turn to the therapist at the place of residence, less often - to the doctor of the antitumor office of the polyclinic.

Without a prescription at the pharmacy today, you can only get non-steroidal anti-inflammatory drugs (below there is an instruction on how to get the necessary painkillers for a cancer patient in a timely manner).

Standard pain therapy regimens

At each examination of an oncological patient, the attending physician evaluates his subjective sensation of pain and, in prescribing painkillers, moves up a three-step ladder from bottom to top. You don't have to go through the steps sequentially. The presence of severe unbearable pain immediately suggests a transition to stage 3.

Stage 1 - mild pain Stage 2 - severe pain Stage 3 - unbearable pain

Stage one - mild pain

At the first stage of anesthesia in oncology, there are non-steroidal anti-inflammatory drugs with an analgesic effect (Ibuprofen, Ketoprofen, Diclofenac, Celecoxib, Lornoxicam, Nimesulide, Etoricoxib, Meloxicam) or Paracetamol.

Cancer pain pills

Injections at the first stage

For all types of cancer pain, except bone:

• Ketanov(or more efficient Ketorol) in a separate syringe.
• Papaverine to enhance efficiency. If the patient smokes, then papaverine will be ineffective.

For bone pain:

• Neither papaverine nor Ketanov can be compared in effectiveness with bone pain with Piroxicam, Meloxicam, Xefocam. Choose one of the drugs and inject in a separate syringe.
• In case of primary bone tumors or metastases in them, it is advisable to discuss with the doctor the use of bisphosphonates, radiopharmaceuticals, Denosumab. In addition to pain relief, they also have a therapeutic effect.

If the patient does not suffer from low blood pressure and the body temperature is normal, then Relanium, Sibazol.

The above funds can be supported by auxiliary

• anticonvulsants- Carbomazepine, Pregabalin (Lyrica), Lamotrigine,
• central muscle relaxants- Gabapentin (Tebantin),
• tranquilizers- Clonazepam, Diazepam, Imipramine. Improve sleep, provide sedative effect enhances the effect of narcotic analgesics.
• corticosteroids- Prednisolone, Dexamethasone. They increase appetite, in combination with painkillers they give an effect on pain in the spine, bones, pains of internal organs.
• neuroleptics - Galaperidol, Droperidol, enhance analgesics and are antiemetic.
• anticonvulsants- Clonazepam, effective for shooting pains, enhances narcotic analgesics.

The second stage - moderate to severe pain

Because first-line drugs become ineffective Paracetamol (or non-steroidal anti-inflammatory drugs) in combination with weak opioids (codeine-containing or Tramadol) is required.

With such pains, pills are more often prescribed for oncology:

• Tramadol - it is prescribed in the first place, just when non-narcotic painkillers are already helping. It is taken either as a tablet (often causing nausea) or as an injection. Together with NSAIDs (Paracetamol, Ketorol). Tramadol should not be taken together with narcotic analgesics and with MAO inhibitors (Fenelzine, Iproniazid, Oklobemide, Selegiline).
• Zaldiar is a complex preparation of Tramadol and Paracetamol.

• Tramadol + Relanium (in different syringes)
• Tramadol and Diphenhydramine (in one syringe)
• Codeine + Paracetamol (max daily intake 4-5 thousand mg.).

To achieve an effect and at the same time reduce pain with as few drugs as possible, you need to combine Codeine or Tramadol with other NSAIDs (Paracetamol, Ketorol, etc.).

Further, it is possible to prescribe Paracetamol with small doses of Fentanyl, Oxycodone, Buprenorphine, which are strong opioid analgesics. The combination is reinforced with adjuvant therapy from the first stage.

Stage three - severe pain

For severe pain or constant pain, such as stage 4, high doses of Tramadol or Codeine no longer help. A cancer patient needs strong opioids in combination with paracetamol and auxiliary muscle relaxants or tranquilizers.

Morphine is a drug prescribed in oncology for unbearable pain. In addition to the analgesic effect, it also has all the side effects of a strong drug (addiction, addiction), after its use there will be nothing to help, there will be no choice of means. Therefore, the transition from weak (Tramadol) to stronger ones should be very carefully considered.

List of analgesics that are desirable to use before Morphine:

List of narcotic painkillers from weaker to stronger:

• Tramadol - according to some sources, it is considered a synthetic analogue of drugs, according to other non-narcotic analgesics.
• Trimeperidine - in tablet forms, the effect is 2 times lower than injectables, less side effects compared to morphine.
• Buprenorphine is slower to develop tolerance and dependence than morphine.
• Pyritramide - the action is very fast (1 minute), compatible with neurotropic drugs.
• Fentonyl is more convenient, painless and effective to use in a patch, rather than intramuscularly or intravenously.
• Morphine - the effect occurs after 5-10 minutes.

The doctor should offer these drugs to the patient, but as a rule, the patient's relatives need to take the initiative and discuss with him the possibility of using less powerful opiates than Morphine after non-narcotic drugs.

Choice of route of drug administration

1. Tablets for oncology and capsules are almost always convenient, except for cases of difficulty swallowing (for example, with cancer of the stomach, esophagus, tongue).
2. Skin forms (patches) allow the drug to be gradually absorbed without irritation of the mucous membranes of the gastrointestinal tract and sticking the patch once every few days.
3. Injections are more often performed intradermally or (when there is a need for rapid elimination pain) intravenously (eg, bowel cancer).

For any route of administration, the selection of dosages and frequency of drug administration is carried out individually with regular monitoring of the quality of anesthesia and the presence of an undesirable effect of substances (for this, an examination of the patient is indicated at least once every ten days).

injections

• Pain injections are represented by: Tramadol, Trimeperidine, Fentanyl, Buprenorphine, Butorphanol, Nalbufinlm, Morphine.
• Combined agent: Codeine + Morphine + Noscapine + Papaverine hydrochloride + Thebaine.

Tablets, capsules, drops, patches

Non-injectable options for opioid pain medications:

• Tramadol in capsules of 50 mg, tablets of 150, 100, 200 milligrams, rectal suppositories of 100 milligrams, oral drops,
• Paracetamol + Tramadol capsules 325 mg + 37.5 milligrams, coated tablets 325 mg + 37.5 middigrams,
• Dihydrocodeine extended-release tablets 60, 90, 120 mg,
• Propbuccal tablets 20mg
• Buprenorphine skin patch 35mcg/hour, 52.5mcg/hour, 70mcg/hour,
• Buprenorphine + Naloxone sublingual tablets 0.2 mg/0.2 mg,
• Oxycodone + Naloxone long-acting tablets 5 mg / 2.5 mg; 10 mg / 5 mg; 20 mg / 10 mg; 40 mg / 20 mg,
• Extended release tapentadol tablets 250, 200, 150, 100 and 50 milligrams,
• trimeperidine tablets,
• Fentanyl skin patch 12.5; 25; 50, 75 and 100 mcg/hour, sublingual tablets.
• Morphine extended release capsules 10, 30, 60, 100 milligrams, extended release tablets 100, 60, 30 milligrams.

How to get painkillers

The appointment of light opioids is signed by the chief medical officer once, then a second discharge can be made by the doctor himself. The re-starter looks at the arguments for changing the dose or switching to another drug (for example, amplification).

Today, if any normal recommendation alnalgologist (stepwise increase in therapy), then they move along it and no one waits for anything for a long time:

• They inject Ketorol, less often Diclofenac, then immediately switch to Tramadol (with increased pain).
• Three times taking Tramadol in combination with paracetamol and Gabapentin without effect - they switch to Durgesic (Fentanyl).
• After increasing the dosage to the maximum or the impossibility of using patches, they switch to morphine.

Cutaneous options - fentanyl and buprenorphine pain relief patches are the preferred alternative to oral opioids. It is a strong pain reliever with gradual release. medicinal substance. The question of their appointment rests on the price tag and availability.

• If the patient has a disability group, and he is entitled to preferential drug coverage

the issue of extracting the same Fentanyl (Dyurgesic) is carried out at the place of residence by the local therapist or surgeon of the antitumor office (if there are recommendations from the analgologist, filling out the documentation - a preferential prescription and a copy of it signed by the head of the medical institution at the initial discharge of the drug). In the future, the local therapist can prescribe the medication on his own, turning to the help of the chief medical officer only when adjusting dosages.

• In the case when a person with a disability has refused drug provision and receives monetary compensation for it

he can start getting the required pills, capsules or patches free of charge. It is necessary to obtain a free-form certificate from the local doctor about the need for expensive therapy indicating the drug, its dose and frequency of use, stamped by the doctor and the medical institution, which must be submitted to Pension Fund. Preferential drug coverage is restored from the beginning of the month following the submission of the certificate.

To receive Fentanyl in a patch, the patient must:

• Contact the pharmacy in person or fill out a power of attorney in the name of a relative in a medical institution.
• As before initiating other therapy, the individual is asked to complete informed consent before initiating therapy.
• The patient is given instructions on how to use the skin patch.
• Disability in oncological pathology should be started from the moment the diagnosis is verified and the results of histology are received. This will make it possible to use all the possibilities of pain therapy by the time the chronic pain syndrome appears and its progression.
• In the absence of opportunities to get a skin patch for pain relief for free or buy for one's own money, a person is offered morphine in one of the dosage forms. Injectable forms of Morphine are also prescribed if it is impossible to provide the patient with non-parenteral forms of opioids. Injections are performed by SPs or hospice workers in the patient's area of ​​residence.
• All cases of undesirable effects of the drugs received or incomplete pain suppression should be reported to your therapist. He will be able to correct the treatment, change the treatment regimen or dosage forms.
• When switching from one opioid to another (due to inefficiency, side effects), the initial dosage of the new drug is chosen slightly lower than that shown in order to avoid dose summation and overdose phenomena.

Thus, adequate analgesic therapy for cancer patients in the Russian Federation is not only possible, but also available. It is only necessary to know the procedure and not to waste precious time, showing forethought.

Cancer continues to be one of the leading causes of death worldwide. Despite numerous studies in this area, the mechanism leading to the transformation of healthy cells into malignant ones is not yet known to specialists. Search effective means from cancer continue. What can modern medicine offer?

Diclofenac as a cure for cancer

Recently, ecancermedicalscience published the results of a study investigating previously unknown properties of a popular pain reliever. The studies were initiated by the International Project Repurposing Drugs in Oncology (ReDO). The data obtained allow us to state: Diclofenac can be used as an effective anticancer drug.

Diclofenac belongs to the group of non-steroidal anti-inflammatory drugs. It was developed in the 70s of the last century and has traditionally been used as an analgesic and anti-inflammatory agent for rheumatoid diseases, problems with the musculoskeletal system, pain syndrome of various etiologies.

Experts are interested in Diclofenac as a means of prevention and treatment various kinds cancer over 30 years ago. Studies have been carried out on an animal model. The drug was administered to experimental mice with fibrosarcoma. At the same time, a significant slowdown in tumor growth was recorded. Research has been continued. It turned out that Diclofenac is able to suppress the division of malignant cells also in ovarian cancer, pancreatic cancer, melanoma, glioma, rectal and colon cancer, neuroblastoma.

The results of new studies show that such therapy can be quite effective. The advantages of the drug are its low toxicity, well-studied pharmacokinetics and low cost.

Diclofenac is often used as an analgesic for cancer and after surgery to remove the tumor. The results of the analysis of data from patients who underwent such therapy revealed a number of positive changes in them, including:

1. Decreased mortality rates and the risk of metastasis in tumors of the breast, kidneys, and lungs.
2. Reducing the size of the tumor in aggressive fibromatosis.
3. Slowing the progression of pancreatic adenocarcinoma.

Scientists believe that the anti-cancer properties of Diclofenac are associated with six main factors:

1. The drug inhibits a special enzyme synthesized by prostaglandins - an inhibitor of cyclooxygenase of the second type. Prostaglandin E2 has been found in a number of tumors. It supports chronic inflammation, thereby forming a tumor microenvironment.
2. Diclofenac produces an immunomodulatory effect.
3. The drug inhibits the growth of blood vessels that supply the tumor with nutrients.
4. It activates apoptosis of cancer cells (regulated process of programmed cell death).
5. The tool helps to increase the sensitivity of cancer cells to chemotherapy and radiation therapy.

Based on the data obtained, scientists express hope that Diclofenac can be used as a fairly effective anticancer agent in the near future.

The benefits of ionized air in oncological diseases

In the middle of the last century, scientists discovered that air with a high content of air ions inhibits the growth of transplanted tumors in animals. Later, the same effect was found in cancer patients. For example, 10-20 sessions of aerotherapy led to a significant reduction in the size of the tumor or its complete disappearance in women suffering from mastopathy.

Russian scientist A.L. Chizhevsky at one time suggested that there is a definite connection between the development of malignant neoplasms and the systematic lack of air ions in the air. Deficiency of air ions creates a background for disruption of electrical exchange, a decrease in the electrical potential of cells, leads to early aging of the body and the formation of neoplasms.

Thanks to the unique NIKKEN filter, the device performs ultrafine water purification, removing the smallest contaminants, chemical compounds, bacteria and saturating it with important minerals.

Stabilizes the pH to the optimum for the body indicators of 7.4-7.8.

Saturates the water with oxygen.

Improves its structure for better penetration into cells.

Ionizes water.

Improves pH level

Saturates with oxygen.

Structures water for better absorption by the body.

Immunotherapy in the treatment of cancer

Today, experts focus on the search for safe methods of cancer treatment. In addition to the traditional surgical intervention, chemotherapy, radiation therapy), other techniques are used.

Immunotherapy is one of the most promising areas. modern medicine offers a range of activities to support the work immune system, strengthening immunity.

1. Vaccination. Two types of vaccines are used: to prevent disease and to treat an already developed disease. They are produced on the basis of malignant cells removed from the body.
2. Preparations based on cytokines. Cytokines are special proteins through which information is transmitted from one cell to another.
3. T cells. These specific cells show high activity in the fight against cancer.
4. Monoclonal antibodies, deoxynate, thymogen. Listed medicines activate the immune system to fight the disease on its own. In addition, they help to eliminate toxic substances from the body.
5. 5.TIL cells. They are isolated from cancerous tissues and injected into the body after reproduction in the laboratory. The technique is aimed at preventing the recurrence of cancer.
6. Natural methods of immunotherapy. Scientists advise using natural organic products that help improve the functioning of the immune system. However, they warn of the need to continue conventional treatment. In other words, fortified with vitamins natural products, herbal remedies can only be used as part of adjuvant therapy.

We offer unique company products NIKKEN, which have proven themselves as powerful immunostimulating agents. On our website you can buy:

Attention! Cancer patients should be under mandatory medical supervision. The use of any additional funds is possible only simultaneously with the treatment prescribed by specialists.

Today, a malignant disease is one of the most terrifying diagnoses. It scares not only the possibility of a fatal outcome, but also the information known to all about severe pain. It should be noted that each of the cancer patients at some stage is faced with this condition.

Therefore, pain medication for stage 4 oncology is an integral part of therapeutic measures. According to statistics, more than half of patients at the stage of metastatic penetration have insufficient control over the pain syndrome. About a quarter, in fact, die not from cancer, but from unbearable pain.

Initial Condition Assessment

Comprehensive assessment is the most important step for successful pain management. It should be carried out regularly and include components such as:

• heaviness;
• duration;
• quality;
• location.

The patient determines them independently, based on individual perception. For a complete picture, testing is carried out at specified intervals. Monitoring takes into account not only subjective feelings but also the effect of previous treatment.

To facilitate an adequate assessment, a scale of pain intensity from 0 to 10 is used: 0 - its absence, 10 - the level of the maximum possible patience.

Types of pain in oncology

Information about the types of cancer pain allows you to choose the right methods of management. Doctors distinguish 2 main types:

1. Nociceptive pain stimulus is transmitted peripheral nerves of receptors called nociceptors. Their functions include the transmission of information about trauma to the brain (for example, invasion of the bone, joints, etc.). It is of the following types:

• somatic: sharp or dull, clearly localized, aching or squeezing;
• visceral: poorly defined, deep with signs of pressure;
• associated with invasive procedures (puncture, biopsy, etc.).

1. neuropathic- the result of mechanical or metabolic damage to the nervous system. In patients with advanced cancer, it may be due to infiltration of the nerves or nerve roots, as well as exposure to chemotherapeutic agents or radiation therapy.

It must be borne in mind that cancer patients often have a complex combination of pain syndrome, which is associated with both the disease itself and its treatment.

What is the best pain reliever for stage 4 oncology?

More than 80% of cancer pain can be controlled with inexpensive oral medications. They are assigned based on the type of pain, their characteristics, the place of occurrence:

1. Remedies based on variety include:

• Nociceptive pain responds relatively well to traditional analgesics, including non-steroidal anti-inflammatory drugs and opioids.
• The neuropathic pain nature of a metastatic tumor is difficult to treat. The situation is usually treated with antiepileptic drugs or tricyclic antidepressants, which model their action by releasing neurotransmitter chemicals such as serotonin and norepinephrine.

1. The WHO proposes such an analgesic ladder for the systemic management of cancer pain, depending on the severity:

• the pain threshold on the scale is determined to a maximum of 3: non-opioid group, which is often made up of conventional analgesics, in particular Paracetamol, steroid drugs, bisphosphonates;
• pain increases from mild to moderate (3-6): a group of medications consists of weak opioids, such as "Codeine" or "Tramadol";
• the patient's sense of self is aggravated and increases to 6: therapeutic measures foresee strong opioids such as Morphine, Oxycodone, Hydromorphone, Fentanyl, Methadone or Oxymorphone.

1. Compliance with the group of drugs and indications for use include:

• non-steroidal anti-inflammatory drugs: bone pain, soft tissue infiltration, hepatomegaly (Aspirin, Ibuprofen);
• corticosteroids: increased intracranial pressure, nerve compression;
• anticonvulsant drugs are effective in paraneoplastic neuropathy: Gabapentin, Topiramate, Lamotrigine, Pregabalin;
• local anesthetics act locally to relieve discomfort from local symptoms such as mouth ulcers caused by chemotherapy or radiation treatment.

Anti-pain drugs of the first group for stage 4 oncology

Used for mild pain. Among them stand out:

1. Anti-inflammatory: “Acetaminophen” (paracetamol), “Aspirin”, “Diclofenac”, etc. Act in combination with more strong means. May affect liver and kidney function.
2. Steroids ("Prednisolone", "Dexamethasone") are useful for removing pain symptoms associated with the pressure of the growing tumor on the surrounding tissues.
3. Bisphosphonates relieve pain in malignant formations of the breast and prostate glands, spread to bone structures.
4. Selective cyclooxygenase type 2 inhibitors(“Rofecoxib”, “Celecoxib”, etc.) is a new generation of drugs that have analgesic and antitumor effects without affecting the functioning of the gastrointestinal tract.

Moderate pain medications for stage 4 cancer

These include:

1. “Codeine” is a weak opioid that is sometimes given with paracetamol or other medications.
2. Tramadol is an opioid drug in tablets or capsules that is taken every 12 hours. The maximum dose for 24 hours is 400 mg.