CANCER PAIN AND TREATMENT
While the probability of pain in cancer patients is 38% in the early period, this rate reaches 85% as the disease progresses and impairs the quality of life. Although this complaint of pain is directly related to the invasion and compression of the tumor (85%), it is related to the treatment of the tumor in 17% (postthoracotomy pain, postmastectomy pain, plexus fibrosis, myelopathy, chemotherapy-induced neuropathy, mucositis), and in 9% of the tumor disease (herpes zoster). , decubitus, constipation) and 9% non-tumor (migraine, diabetes) causes. Tumor patients may have both somatic pain and neuropathic pain. For example, while a cancer patient complains of somatic nociceptive pain due to vertebral bone metastasis, he also complains of neuropathic pain due to epidural/spinal cord compression.
Cancer pain can be either continuous or intermittent or in the form of sudden exacerbations (sudden increasing pain – leakage pain). Leakage pain seen in 2/3 of cancer patients occurs especially with swallowing, coughing, defecation-micturation and movement and is severe, short-lived and difficult to control. In addition to the basal medical treatment of the patient, the use of short-acting drugs (such as transdermal fentanyl, SC morphine..) will provide pain relief.
For successful pain management in cancer patients, cooperation between patient-oncology-algology-patient relatives is absolutely necessary. Although systemic analgesic therapy in accordance with the WHO step principle is essential in the treatment, interventional pain treatment (epidural/spinal catheter/port application, neurolytic blocks, radiofrequency thermocoagulation) should definitely be added to the treatment plan in appropriate patients.
Systemic analgesic treatment should be started with nonopioids (NSAID, Paracetamol, metamizole) for mild pain, weak opioids (codeine cachet-syrup, tramadol drops-capsule-retard tablet) for moderate pain, according to the step principle recommended by WHO. If it is painful, strong opioids (morphine oral tablet, jurnista, transdermal-transmucosal fentanyl) should be used. Attention should be paid to dose titration at all steps. When starting systemic analgesic treatment, stable analgesia can be achieved if the treatment is continued with long-release opioids after the total daily dose is found with SC or IV short-acting opioids (morphine amp) within the first 24-48 hours. In the meantime, short-acting opioids can be used if needed in the treatment of increased pain. In cancer pain with a neuropathic component, the addition of anticonvulsants should not be forgotten.
Interventional methods in cancer pain:
Intraspinal (EP/IT) or peripheral applications should be applied when systemic analgesics cannot provide adequate analgesia or have intolerable side effects. Nondestructive (intraspinal or plexus analgesia) and destructive (radiofrequency thermocoagulation, alcohol, phenol application to the sympathetic ganglion or peripheral nerve) analgesic methods can be used.
