Analgesic treatment in non-immune diseases
Analgesic treatment is an integral part of anti-cancer therapy. It aims to relieve the suffering of patients and prevent the destructive influence of pain on the lifestyle of the patient and his family. Pain can occur at any stage of cancer and occurs on average in 50%, and in advanced disease in more than 75% of patients. The basic method of treating pain in patients with cancer is pharmacotherapy carried out according to the scheme of the “analgesic ladder”.
Currently, the following categories of cancer pains are distinguished:
- Pain caused by cancer or its metastases: pain caused by the growth of the tumor, the pressure of the tumor on the nerves, metastases to the bones, skin, and parenchymatous organs.
- Pain associated with cancer cachexia: pain caused by pressure sores, constipation, inflammation of oral mucous membranes, esophagus, etc.
Pain resulting from previous cancer treatment: chemotherapy can directly cause peripheral nerve injury (polyneuropathy), or as a result of immune deficiency, the cause of the activation of a viral infection, which can give a painful pain syndrome (shingles and postherpetic neuralgia). If irradiated, causing fibrosis of the tissues, it may cause pain in the way of brachial plexus injury or other nerve structures. Post-radiation damage to mucous membranes, e.g. the rectum, is another example of the pain of this group.
Pain which occurs in patients with malignant neoplasms, but is not associated with cancer or previous treatment. A frequently used term for this group of pains is the name “coincidence pain”. These are headaches, lumbar spine, joint pains, and so are those that often also occur in people who do not have a malignant tumor.
In the case of cancer, there is often talk of the so-called total pain, for which, apart from the above-mentioned causes, emotional aspects such as anger, anxiety or depression also have a strong influence. Often, we also encounter a situation in which a “disruption” in the form of additional ailments called “breakthrough pain” is imposed on correctly diagnosed and treated cancer pain. Breakthrough pain is acute transient pain that assumes the form of seizures and overlaps with the existing persistent ailments that accompany the disease. With their intensity, these pains outweigh the basic pain. They affect 40-60% of patients treated for cancer pain. It is characterized by paroxysmal nature, rate of build-up, significant severity and short-term.
To assess pain intensity in patients, a visual analogue scale (VAS) is commonly used. It is a 10-cm segment. Its beginning  means a complete lack of pain, and the end  is the strongest pain that can be imagined. In this section, the patient indicates the point corresponding to the pain he is currently experiencing. The result is recorded as a number corresponding to the number of millimeters (centimeters) from the beginning of the episode.
The treatment of pain, especially pain in cancer, sometimes creates a complex problem for both the doctor and the patient. For a doctor – because he must choose the most effective way of treatment, which will result in the elimination of pain, for the patient – because often a form of effective treatment can affect the limitation of current life activity.
Pharmacotherapy should always be selected individually. What helps one person, the other does not have to help, and can even harm. The choice of the drug must be made on the basis of proper diagnosis and the analgesics used so far. In this case, any undesirable effects that occurred during previous uses of a given preparation or medicines from a given group should be considered.
About 90% of patients with cancer pain can be effectively treated pharmacologically. In simplified terms, the treatment of cancer pains consists of two basic, simultaneously used elements:
the use of painkillers – the type and doses of drugs are selected depending on the severity of pain, according to the analgesic ladder (non-opioid drugs – opioids)
the use of drugs and complementary methods (adjuvant) – the choice of drugs or methods depends primarily on the established diagnosis (adjuvant drugs, blockages, neurolysis, palliative oncological treatment).
How to treat cancer pain?
Most painkillers can be included in one of the following groups:
- nonopioid analgesics (paracetamol and non-steroidal anti-inflammatory drugs);
- weak opioids (opioids with a ceiling effect, tramadol);
- strong opioids;
- supplementary medicines.
The first three groups of drugs (tables 1, 2, 3) are the next steps of the schema (analgesics – analgesic ladder rungs). Drugs from the fourth group – booster drugs are used at every stage of treatment.
The treatment strategy consists of:
- regular drug administration (according to pharmacological properties to ensuring a constant therapeutic level) additional use of rescue doses in cases of additional pain;
- using stronger drugs (higher degree), when weaker patients cease to be effective in combining;
- painkillers with drugs that increase their effect, cause causation or reduce the side effects of treatment (supplementary medicines) of the need to prevent and treat side effects of analgesics (mainly constipation).
There are two basic types of tramadol: a short-acting formulation and a slow-release drug (retard). The market is available in the form
- drops and solution for injection.
Tramadol alone or in combination with paracetamol is effective in the treatment of severe pain.