Treatment of cancer pain

Pain affects 30% -50% of people during active anticancer treatment. In the later phase of the disease, up to 90% of patients suffer.

Cancer is causing around 10% of deaths worldwide (5 million people) in a year. Cancer-related pain affects approximately 6 million people worldwide in both active and advanced stages. It is estimated that approximately 100,000 Poles suffer annually from the pain accompanying the cancer disease (patients both in the active phase of treatment and in the advanced stage of the disease). The scale of the phenomenon is, however, much greater, because cancer pain is most often a problem not only for the patient, but also for his family, carers and the whole environment.

Pain therapy should be an integral part of cancer treatment. Ill-treated pain causes many adverse effects: physical, mental, social, spiritual. Strong pain adversely affects the patient’s body. During cancer, we face acute and chronic pain. During treatment of cancer patients often undergo surgery, painful diagnostic procedures, invasive treatment procedures that cause acute pain with symptoms on the part of the sympathetic nervous system, such as hypertension, accelerated heartbeat, increased metabolism. Then there is a chronic pain that causes negative emotions, anxiety, depression, the patient is convinced that the disease is progressing, that he will die in great suffering. Chronic pain decreases immunity. A person suffering from pain becomes irritable, isolates himself from family and friends, ceases to be self-sufficient, pain disturbs the ability to perform daily activities, causes a decrease in activity, which worsens the quality of life. Patients suffering from pain react less to treatment and die earlier than those who do not feel pain. For the patient, uncontrolled pain is a harbinger of a near death. This is especially true for severe pain. Therefore, the correct treatment of cancer pain is of great importance in the therapeutic process. Pain is a psychosomatic symptom and it is required, apart from the use of painkillers, to fight other annoying symptoms and provide mental, social and spiritual support. Support is also required for the patient’s family.

It has been demonstrated that in the majority (80% -90%) of patients, the pain can be completely suppressed using commonly known and available analgesics recommended by the World Health Organization. However, studies by the World Health Organization have shown that in most patients (50% -80%) the pain is not treated or is treated incorrectly.

The reasons for inappropriate pain management are many, ranging from the fact that patients hide pain, do not report pain to doctors, do not know where to seek help, as well as fear that the drugs used can cause addiction, be ineffective when the pain gets worse more and cause a series of annoying side effects (eg constipation). The administration of strong opioid drugs called wrongly drugs in many patients and their families is often associated with close death. The lack of effective pain treatment results from the failure to prepare medical personnel: doctors are unable to skillfully assess pain and recognize its cause. They do not have sufficient knowledge in the treatment of pain, which in turn is the reason for a significant delay in the use of strong analgesics, incorrect dosing (too small dosages of drugs are used) and inability to recognize and treat side effects. Not always basic medicines are available in pharmacies.

The problem of inadequate cancer pain therapy also applies to Poland. In our country, this contributes to, among other things, the erroneous belief that “cancer must ache”. It was noted that patients with cancer do not report pain to the doctor, and often do not know how to take medications that are prescribed for them. Some doctors incorrectly assess the severity of pain in their patients or are afraid of prescribing more potent formulations. In society, myths about the harmful effects of strong analgesics are rooted in, which makes it difficult to use these useful drugs.

The changes mainly concern those patients who had access to nationwide Outpatient Pain Kits, Palliative Care Hospice Centers, Home Care Teams, or were treated in major oncology centers. Over the past 10 years, the consumption of strong analgesics in Poland has increased many times, which indicates better pain therapy, because these drugs are required by the majority of patients.

Depending on the severity of pain, appropriate drugs should be chosen. In simple pain, simple analgesics, such as paracetamol, suffice. ibuprofen, weak to moderate weak opioid drugs, e.g. tramadol, codeine, and in moderate to severe pain – strong opioid drugs: morphine, fentanyl. In addition to long-known means, the doctor now has next-generation drugs that combine effectiveness with a favorable safety profile, are safe and comfortable to use, and are characterized by a negligible amount of side effects. An example of such a drug is percutaneous fentanyl, a medium widely used in moderate and severe cancer pain. Proven at the leading centers in the world, but also in Poland. In Poland, thanks to the understanding of the Ministry of Health and the policy to meet the needs of patients suffering, this drug is available at a flat rate.

In combating pain in cancer, medicines should be used in such a way that additional suffering is not caused to the patient. It is preferable to administer drugs in forms convenient for the patient and family, e.g. in the form of a patch or tablet. Drugs should be administered at regular intervals (by clock), so that the next dose of the drug administered before the previous dose stops working. Oral drugs should be used depending on the duration of action of the drug every 4 to 12 hours, and the medicine in patches every 3 days. Depending on the cause of the pain, for example in neuropathic pain (caused by damage to the nervous system), additional supportive drugs should be used, eg glucocorticoids, antiepileptics, antidepressants. With skillful, gradual dosing of strong analgesics, treatment is safe. Some patients require very high doses and should not be afraid of this. Choose doses of medication so that the patient does not suffer. Doses should always be selected individually depending on the severity of pain, analgesic effect and side effects.

As a result of slow penetration of fentanyl through the skin, the patch provides a continuous analgesic effect lasting for three days. As a result, patients can live a normal life according to their capabilities. The use of a patch provides a beneficial analgesic effect and fewer side effects (drowsiness, nausea, vomiting, constipation and dizziness). Administration of the drug in the form of a patch is convenient.