Cancer Pain Management

While the probability of pain in a cancer patient is 38% in the early stages, as the disease progresses, this rate reaches 85% and impairs the quality of life. Although this pain complaint is directly related to the invasion and compression of the tumor (85%), it is 17% due to the treatment of the tumor (postthoracotomy pain, postmastectomy pain, plexus fibrosis, myelopathy, chemotherapy-related neuropathy, mucositis). /strong> is due to tumor disease-related reasons (herpes zoster, decubitus, constipation) in 9% and non-tumor reasons (migraine, diabetes) in 9%. Both somatic pain and neuropathic pain can be seen in tumor patients. For example, while a cancer patient complains of somatic nociceptive pain due to vertebral bone metastasis, he additionally complains of neuropathic pain due to epidural/spinal cord compression. Cancer pain is either continuous, intermittent, or has sudden flares (sudden increasing pain - leakage). It occurs in the form of pain). Leakage pain, seen in 2/3 of cancer patients, occurs especially with swallowing, coughing, defecation-micturition and movement, and is severe, short-lived and difficult to control. In addition to the patient's basal medical treatment, the use of short-acting drugs (such as transdermal fentanyl, SC morphine, etc.) will provide pain relief.
Patient-oncology-algology-patient relatives collaboration for successful pain treatment in cancer patients. It is absolutely necessary. Although systemic analgesic treatment in accordance with WHO's step principle is essential in the treatment, interventional pain treatment (epidural/spinal catheter/port application, neurolytic blocks, radiofrequency thermocoagulation) must be added to the treatment plan in suitable patients.
According to the step principle recommended by WHO in systemic analgesic treatment, mild pain should be started with non-opioid (NSAID, Paracetamol, metamizole), moderate pain should be started with weak opioids (codeine cache- syrup, tramadol drop-capsule-retard tablet), and in case of severe pain, strong opioids (morphine oral tablet, jurnista, transdermal-transmucosal fentanyl) should be used. Attention should be paid to dose titration in all steps. When starting systemic analgesic treatment, SK or IVshort-acting opioids (morphine amp). Meanwhile, short-acting opioids can be used if necessary in the treatment of sudden increasing pain. Addition of anticonvulsants should not be forgotten in cancer pain with a neuropathic component.