In clinics, it is common to see patients who come seeking help due to cancer pain. Cancer pain is like an invisible shackle, severely affecting the quality of life of tumor patients. In fact, patients should not just endure cancer pain; scientific management and standardized medication are necessary to ensure quality of life and maintain subsequent treatment. The basic goal of pain relief treatment is to achieve painless sleep, and the optimal goal is to achieve painless rest, and even painless activity on this basis.

Cancer pain​ manifests diversely in patients—it may present as a dull ache, a distending pain, a stabbing sensation, or colicky cramps. The intensity of pain also varies from person to person. Based on the location, cancer pain can be broadly categorized as somatic pain​ or visceral pain. According to the pathological mechanism, it can be classified as neuropathic pain, nociceptive pain, or mixed pain. Based on duration, it may be divided into acute pain, chronic pain, or breakthrough pain.

Overcome the cognitive misconceptions about pain

Many patients and family members have misconceptions about cancer pain, believing it is an inevitable symptom of cancer that can only be endured silently, even mistakenly viewing pain tolerance as a form of strength. These misconceptions may lead patients to miss the best opportunity for intervention.

Myth 1

Save pain medication, afraid to increase dosage, afraid of addiction.

Use pain medication early and standardized according to doctor's advice, which can control cancer pain in its early stages and prevent it from developing into intractable pain. Under the guidance of a doctor, the risk of drug addiction is extremely low when medication is used properly. Doctors will comprehensively assess the pain level and dynamically adjust the medication dosage, increasing it if the pain progresses and gradually reducing or even stopping the medication once the pain subsides.

Misconception 2

It will pass if you just tough it out. It's best to avoid medication if possible.

This mindset is very dangerous. Enduring pain has significant harmful effects on the body, potentially causing a range of issues including anxiety, sleep disturbances, decreased appetite, weakened immunity, and even increasing the risk of falls and infections. Taking medication regularly and as prescribed is essential to maintain stable blood drug concentrations, preventing pain from recurring or worsening.

Misconception 3

Taking strong painkillers means it's no use.

Pain does not necessarily indicate tumor progression or metastasis. About 75% of cancer pain is directly caused by the tumor, about 15% is related to treatment (such as postoperative neuralgia, side effects of radiotherapy and chemotherapy), and about 10% is due to other factors, such as psychological and emotional influences. The use of opioid drugs depends on the severity of pain, not the stage of the disease. Most cancer pain can be effectively controlled through standardized medication, especially for advanced cancer pain patients. The earlier standardized treatment is initiated, the better the effect and the greater the survival benefit.

Myth 4

Once side effects occur, the medication should be stopped immediately.

Besides constipation, side effects such as nausea, vomiting, and dizziness are commonly seen in the initial stages of medication use and usually subside gradually with symptomatic treatment. Constipation can be alleviated through dietary adjustments, laxatives, abdominal massage, and other methods. If medication is stopped without following medical advice, it may lead to recurrent pain or even worsen the condition.

Express pain accurately to your doctor

Describing pain promptly and accurately to your doctor, including its location, intensity, and frequency, is the foundation for developing a personalized pain management plan. Never hide your pain because you're "afraid of trouble" or "afraid the doctor will think you're exaggerating." Only by " daring to speak of pain" can pain be effectively treated. Here are the commonly used cancer pain assessment methods.

Routine assessment: At least once a day.

Quantitative assessment: Use a numerical rating scale (0-10 points). For acute pain patients, elderly individuals, young children, or those with impaired expressive ability, the visual analog scale (VAS) or facial expression scale can be used.

Comprehensive assessment: Includes etiology, pain type, characteristics of onset, treatment status, function of vital organs, psychological and mental state, family and social support, as well as medical history (e.g., psychiatric history, substance abuse history), etc.

Dynamic evaluation: Continuously monitor changes in pain, medication effectiveness, and adverse reactions to adjust treatment plans promptly.

Principles of Rational Drug Use

Drug therapy is the core of cancer pain management and must adhere to five principles: stepwise administration, oral preference, scheduled dosing, individualized dosage, and close monitoring. Currently, the commonly used analgesics mainly include nonsteroidal anti-inflammatory drugs, opioid drugs, and adjuvant analgesics.

The "three-step" principle of analgesia refers to selecting analgesics of different intensities in order from mild to severe pain.

For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are commonly used. They reduce pain by inhibiting the synthesis of inflammatory mediators in the body. For moderate to severe pain, opioid drugs are the mainstay, such as morphine and oxycodone. They act on the central nervous system to block the transmission of pain signals. Adjuvant analgesic drugs include antidepressants, anticonvulsants, etc. They can enhance the pain-relieving effect and are particularly suitable for treating neuropathic pain.

Oral administration is the preferred route of administration for analgesics, as it is convenient, cost-effective, and easy to adjust the dosage. If the patient is not suitable for oral administration, options such as subcutaneous injection, patient-controlled analgesia, or transdermal patches can be chosen. It is recommended to prioritize controlled-release or extended-release medications as the base medication to maintain blood drug concentration. In cases of breakthrough pain, rapid-release opioid drugs can be used for symptomatic treatment.

It should be noted that due to individual differences, there is no standardized dosage for opioid drugs. They must be taken strictly according to the doctor's instructions, on time and in the prescribed amount. Never adjust the dosage yourself, as this may affect the efficacy or cause adverse reactions.

Implementing a Multi-Pronged Approach to Pain Management

Modern cancer pain management has formed a composite treatment system of "pharmacological + non-pharmacological," with the following treatment methods.

Physical therapy

Methods such as heat application, cold application, and acupuncture can alleviate pain to some extent. Heat application can promote blood circulation and relieve muscle tension-related pain. Acupuncture can regulate qi and blood, providing certain pain-relieving effects.

Minimally invasive treatment

Nerve block and spinal cord stimulation techniques can act on pain nerve pathways, significantly reducing the risk of drug dependence and adverse reactions.

Psychological interventions such as cognitive-behavioral therapy, psychological counseling, and relaxation training can effectively break the vicious cycle of pain-anxiety-pain exacerbation.

Exercise prescription

Moderate exercise serves as a natural analgesic and an effective adjunct to pain relief. Activities such as walking, Tai Chi, and yoga can help alleviate physical and mental stress while improving overall physical conditioning.

Social support

Comprehensive support measures, such as care and companionship from loved ones, mutual sharing among patients, and professional assistance from social organizations, are equally important for cancer pain patients and serve as effective emotional remedies to help them cope with the pain.

Pain, as an equally important fifth vital sign as body temperature, blood pressure, respiration, and pulse, effective management is an indispensable core component of medical care. Cancer pain is not an insurmountable challenge, nor should it become a silent burden for tumor patients to endure; it is an independent condition requiring active intervention.