The most common problem of cancer patients are pain. Cancer pain is also an important problem that affects the whole of cancer patients and reduces the life comfort seriously. With it, cancer pain may treated in %80-90 of these patients with an opioid-based analgesic drug also.
The World Health Organization (WHO) recommends three-step sequential ladder therapy. In this therapy have recomended to use of non-opioids, weak opioids and strong opioids according to the severity of the pain.
However, health workers and patients relatives prejudices may the pain release treatment inadequate by up to %80 percent. Cancer patients have more afraid of suffering with pain, than dying.
Untreated pain affects the social relations of patients negatively and causes psychological disorders due to various reasons such as pain-related sleeping disorder.
In this passage I will write about pain causes and treatment in cancer patient.
The primary pain caused by cancer invasion and compression of pain sensitive structures. Sometimes a nerve root or a nerve end can invased with cancer so it caused to irresistible pain. However, tumors that metastasize to the brain may cause severe headache because of brain edema.
The working principles of chemotherapy drugs are usually based on the elimination of proliferating cells. Cancer cells are multiply excessively. For this reason, chemotherapy destroys cancer cells more while it causes destruction throughout the body. Because malignant cells tend to divide much faster than normal body cells. In this way, the most proliferating bone marrow cells from the body will affected by chemotherapy negatively more than other tissues. This will result to severe bone and joint pains. After chemotherapy, this pain will discomfort the patient for several days or several weeks.
Therefore, patients who have given chemotherapy should well hydrated and may also provided to relief the pain, with using powerful painkiller drugs.
Cancer disease is usually seen in middle-aged and advanced-aged people, so cancer is accompanied by many comorbid diseases. Especially osteoarthritis will exacerbated by chemotherapy. The diabetic neuropathy due to diabetes mellitus will exacerbated with chemotherapy also. Depressed wounds and related pains will exacerbated also in bed-depending patients. Migraine pain due to cancer related stress can aggravated also. Chemotherapy sekonder immunosuppression may cause to postherpetic neuralgia, that have third-degree serious pain.
First, Nonsteroidal anti-inflammatory drugs should used. These drugs that inhibit Cox 2 may used, these drugs are ibuprofen, flurbiprofen, acetylsalicylic acid, diclofenac, naproxen and indomethacin etc. NSAID are nephrotoxic like chemotherapy drugs and can only used in patients that have not renal insufficiency. They may also cause to exacerbate gastritis and duodenal ulcers. In addition, Cox 3 inhibitor drug, paracetamol can used in combination with other nonsteroidal antiinflammatory drugs for the treatment of mild pain in cancer.
This group patients can not treated with Nonsteroidal anti-inflammatory (NSAID) and paracetamol medication. In addition to NSAID drugs, weak opioids such as codeine, dihydrocodeine, tramadol or propoxyphene should added to treatment. Tramadol is act to central nervous system. Is also a synthetic analgesic with monoaminergic activity and significantly enhances the comfort of patients.
Strong opioids will also added to the treatment. These drugs are morphine, hydromorphine, buprenorphine, methadone, fentanyl, alfentanil and heroin. In this drug family, fentanyl patches are most commonly used.
Caution: All opioid drugs are subject to abuse and misuse, so these drugs are subject to Controlled Drug restrictions.