Rehabilitation Dept. of Peking University Cancer Hospital: Home Cancer Pain Management Lecture & Free Clinic | He Yi, Wang Yan
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About 50% of cancer patients experience varying degrees of pain, with 70%–90% of advanced-stage patients experiencing it.
Persistent severe cancer pain is a primary cause of depression. In China, only 30% of patients achieve effective pain relief, far below international standards (where 80%–90% can become pain-free with standardized treatment).
For advanced cancer patients, pain management is crucial.
Cancer pain is not a symptom to be "endured," but a disease requiring independent management. Standardized analgesia (medication + interventional + non-pharmacological) not only restores patients' dignity but also improves prognosis by breaking the "pain–tumor progression" cycle. Patients and families should actively communicate pain levels, dispel misconceptions, and work with a multidisciplinary team to develop personalized plans, aiming for a "pain-free life."
The Rehabilitation Department of Peking University Cancer Hospital is one of the earliest in China dedicated to psychosocial oncology rehabilitation. It plays a vital role in psychosocial oncology, palliative care, and symptom control, alleviating various symptoms during cancer diagnosis and treatment, such as pain, insomnia, vomiting, anorexia, anxiety, depression, and delirium. The department also provides psychological counseling and therapy for patients and families, offering biofeedback, meditation, and CES sleep devices, alongside traditional Chinese medicine, physical therapy, and massage for cancer rehabilitation.
This event features a lecture on home cancer pain management by Prof. He Yi and Prof. Wang Yan from the Rehabilitation Department of Peking University Cancer Hospital, along with an online free clinic for Panda community members troubled by cancer pain.
June 19 (Thursday) 19:30, we look forward to seeing you there.
Extended Learning:
Classification of Cancer Pain in Gastrointestinal Tumors:
1. Visceral pain caused by tumor invasion;
2. Compression pain from enlarged lymph nodes;
3. Neuropathic pain;
4. Bone pain, soft tissue pain, etc., caused by distant metastasis.
Main Approaches to Managing Cancer Pain:
Divided into a three-step analgesic ladder:
Step 1: Antipyretic and analgesic drugs (e.g., for colds/fever);
Step 2: Low-dose opioids, such as 5mg morphine or oxycodone.
Step 3: For severe pain, higher doses of morphine, oxycodone, or fentanyl.
How to Determine the Dosage of Pain Medication?
Initially, doctors calculate the daily dosage according to guidelines, converting in-hospital titration or home oral doses into extended-release equivalents via formulas. Experienced clinicians may adjust extended-release doses or combine immediate- and extended-release medications. The primary goal is to relieve patient suffering as quickly as possible.
Is a Narcotic Card Required to Prescribe Pain Medication?
Anti-inflammatory drugs and low-dose or Step 1/2 opioids do not require one. Stronger medications do.
This is legally mandated, but hospital departments collaborate to streamline the process, making it very convenient for patients.
Should the Narcotic Card Be Processed at the Rehabilitation Dept. or the Primary Treatment Dept.?
Either is fine, but it is more convenient at the Rehabilitation or Pain Management Department.
Requirements: Patient's ID and malignant tumor diagnosis certificate. For first-time applications, if the patient cannot attend, a video consultation with the doctor is acceptable to help determine the need for strong analgesics.
Is It True That All Cancer Pain Can Be Eliminated If Managed Well?
Theoretically, yes. In practice, 90% of patients can achieve pain relief. The remaining 10% are harder to manage and may require interventional procedures.
Why do many patients still experience pain in reality? Two reasons:
First, clinicians must have strong pain management skills, be thoroughly familiar with each medication, know how to combine drugs for comprehensive relief, manage side effects, and optimize their use.
Second, patient compliance. Taking medication irregularly can turn manageable pain into complex, refractory pain.
How to Manage Adverse Reactions to Pain Medication?
Common side effects fall into three categories:
1. Constipation: Eat more fiber-rich foods and take preventive laxatives like lactulose, hemp seed pills, or moderate senna. Treating constipation after it occurs can affect drug efficacy.
2. Respiratory depression: Medication selection requires clinical oversight. Symptoms like excessive drowsiness, confusion, or delirium are very rare.
3. Addiction: The risk is very low for patients in pain. Following principled dose adjustments significantly reduces addiction risk. Antidepressants or combination therapies can also help. Clinical addiction is rare. Compared to the tumor itself, addiction is not a major concern.
Does Pain Mean the Cancer Is in the Late Stage?
Not necessarily. About 20% experience pain at initial diagnosis, and around 30% may still have it after treatment. In advanced stages, the rate can reach up to 50%.
For example, lung cancer damaging intercostal nerves can cause allodynia, where patients cannot tolerate clothing, even silk. Some cannot shower because water touching the skin causes pain. This is known as allodynia.
What Pain Medications Are Available?
1. NSAIDs, such as acetaminophen;
2. Opioids, including weak and strong opioids;
3. Psychiatric and neurological drugs, such as pregabalin and gabapentin for seizures, amitriptyline for burning neuropathic pain, and lidocaine for local anesthesia;
4. For allodynia, venlafaxine, duloxetine, etc.;
5. Antidepressants.
When Should Pain Patches Be Used?
The principle is to use oral and non-invasive routes whenever possible. For GI tumors, oral meds may increase digestive burden, or patients may take too many pills or experience nausea/vomiting. In these cases, patches are a good alternative.
Ultimately, patients can choose the most comfortable pain relief method based on their condition.
Which Patients Are Suitable for Pain Pumps?
Pain pumps are invasive but use the same class of drugs as oral medications. Therefore, about 90% of patients can be effectively managed with routine non-invasive methods like oral meds, patches, and comprehensive therapy.
If oral meds and patches are ineffective, a pump may not help either. Only a small subset of patients, such as those unable to swallow, may benefit.
Additionally, for certain pains like bone pain, underlying issues should be addressed with bone cement or radiotherapy rather than relying solely on analgesics. Oral meds and patches often manage it well, making invasive procedures unnecessary.
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