Cancer pain is pain that appears in people with cancer. It is an intense and disabling pain that can arise from the pressure of the tumor itself, from treatment against it or from alterations in the immune system, among other causes.
Today, cancer is one of the most important health problems in our environment. In Spain, it is estimated that around 90,000 people die from cancer each year. Additionally, of all cancer patients undergoing treatment, it is estimated that nearly 40% experience cancer pain.
Unfortunately, in the final stages of cancer, this pain appears in almost 80% of patients. This is a complex situation that is difficult to address. Each person responds in a way to a certain treatment and many of them are very powerful drugs.
However, currently, much progress is being made in this field and, little by little, new treatment guidelines are appearing. In this article we explain opioid treatment for cancer pain.
What does cancer pain treatment consist of?
As we have already mentioned, the treatment of cancer pain must be individualized. That is, it must be specially adapted to each patient, since it depends on the type of cancer suffered, what is causing it and even each person's perception of pain.
However, there is a general guideline for the treatment of cancer pain depending on its intensity. It is a scale that was determined by the World Health Organization. From least to greatest intensity of pain, the following groups of drugs are used:
- Simple pain relievers, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs): These are used in people who suffer from mild pain. The most used are ibuprofen or naproxen.
- For patients suffering from moderate pain, the second step of treatment is weak opioids: in this group we find codeine, tramadol or dihydrocodeine.
- When the pain is very intense, very strong opioids are used: the most used is morphine, but methadone or fentanyl are also used.
In order to classify pain, it is necessary to carry out a good assessment of the patient. For this, the so-called pain scales are used. Pain scales give scores to different aspects of pain to classify it somewhere between mild and unbearable.
Normally, in these people, pain is caused by more than one mechanism. Therefore, it may be necessary to combine several medications. It is important to be aware that, unfortunately, more than half of patients end up needing third-tier medications.
What are opioid drugs?
Opioid drugs are those that have been obtained from opium and that also act on brain receptors called opioid receptors. They are distributed throughout the central and peripheral nervous system.
What these drugs do is bind to these receptors and stop nervous stimuli. Thus, by stopping the stimulus, the transmission of pain does not occur.
However, it must be taken into account that these medications have numerous side effects. First of all, it is important to highlight that many opioids, such as morphine, cause dependence.
Likewise, they can increase the feeling of tiredness and weakness. Another risk is that they are associated with depression of the respiratory system. Therefore, you have to be very careful with the dosage and they should always be used under medical prescription.
What is the treatment regimen for cancer pain with opioids?
Second step: weak opioids
- As we have already indicated, the most used drugs in this category are tramadol and codeine. They can be administered in different ways: so that their release is delayed or so that they act directly. They can also be combined with other drugs, such as NSAIDs.
- In the case of codeine, for example, it is usually taken orally. Initially, the patient can take 30 mg every 4 to 6 hours. However, it is not recommended that you ever take more than 60 mg every 4 hours. It should also not be used in patients who have liver or kidney problems.
Third step of cancer pain: strong opioids
- These drugs are reserved for cases in which cancer pain is already almost intolerable. The most used is morphine. This is because it can be used in numerous ways, such as subcutaneously.
- Furthermore, morphine has no 'analgesic ceiling'. That is, the more doses administered, the greater its effectiveness. In fact, the dose limit is set by its side effects, since an overdose can cause death.
Complementary use of cannabis and opioids can improve quality of life
There have been several studies in the past that have argued that cannabis also has analgesic properties and could be an alternative treatment for pain patients. A study from the University of New Mexico (USA) investigated how cannabis can reduce the absorption of opioids in patients with pain. In the study, 37 pain patients enrolled in the Medical Cannabis Program (MCP) were compared to 29 patients who were not enrolled in the program. The patients were also treated with cannabis, in contrast to the control group. Over a 21-month period, researchers observed patients being prescribed opioids.
Patients with MCP were found to use fewer opioids after being enrolled in the program for one year than those who did not participate. While most patients reduced their opioid dosage, others stopped using opioids completely. This ultimately had a positive effect on the quality of life of the patients, who also experienced improvements in their "social life", their activity level and their concentration. On the other hand, there were only minor side effects from taking cannabis.
Based on these findings, the authors concluded that there is a relationship between the inclusion of patients in the MCP and their decrease in opioid consumption, as well as the improvement in their quality of life. Therefore, they call for “further research into cannabis as a potential alternative to prescription opioids for the treatment of chronic pain.”
Treatment with opioids for cancer pain is complex and must be chosen according to the characteristics of each patient. Therefore, it must always be a doctor who chooses it and decides what the regimen should be.
PRONAPRESA
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