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The fight against pain in terminally ill
Malignant tumors in stage maloboleznenny not running. Pain symptom occurs only with the transition of tumor in the pleura, serous membrane of the stomach, the capsule of the pancreas or liver. The continued growth of the tumor is accompanied by a growing stream of pain from compression of the neuro-receptor apparatus of the surrounding tissue or a tumor associated inflammatory infiltrate. Less commonly, the pain are the result of sprouting of the nerve trunk of a malignant tumor.
The problem with pain control in patients with clinical group IV is the first and most difficult. Analgesics should be administered only by medical oncologists. For successful treatment of pain in cancer patients requires an individual selection of means and methods of pain relief, depending on the structure of pain and its intensity.
In the observation of patients at home, oncologists are beginning to use drugs combined action - an analgesic and anti-inflammatory. These are derivatives of salicylic acid, pyrazolone paraaminofenola.
The pharmaceutical industry produces a large number of these drugs, the most effective combination of these drugs in tablets, coated tablets, with a pronounced analgesic and anti-inflammatory action.
Prolonged use of analgesics in large doses, sometimes leading to irritation and damage to the gastric mucosa - drug gastritis. If signs of this complication, transferred to a local administration of solutions. If you can not be introduced through the mouth of analgesia (repeated vomiting, obstruction of the esophagus) are inserted through the rectum.
The intensity of pain depends on the extent of the damaging effect of a malignant tumor on the neuro-receptor apparatus of the surrounding tissue, the type of higher nervous activity of the patient and his emotional state at the time.
Many patients in varying degrees, expressed as the phenomenon of neurotic, neurosis-like states, mental depression, anxiety, fear, disbelief in the possibility of alleviating their suffering. This is an unfavorable background for eliminating or reducing pain.
To remove the patient's psychological stress and deal effectively with the pain shall be appointed psychopharmacological drugs. Drugs such as chlorpromazine, metamizila, oksilidina, trisedila etaperazina and, in addition to psychopharmacological, calming the central nervous system actions, enhance analgesic effect of analgesic, narcotic and hypnotic drugs.
Remove the patient's psychological tension, emotional background to make it more favorable to the effects of analgesics can not just drugs. Word and suggestion are often more effective. Psychotherapy may reduce pain, and sometimes completely eliminate them.
Attention, a kind word, encouraging ongoing clarification of therapeutic measures to create sympathy for the patient cares for him, distract his mind from the pain. This is an essential element of psychotherapy, facilitating the patient's condition, inspiring hope.
Pain patients is not always possible to eliminate the analgesic, psychopharmacological drugs and psychotherapy. During germination of malignant cells in the posterior roots of spinal nerve trunk, pelvis, etc., must appoint narcotic analgesics. These funds have rapidly advancing analgesic effect, but their prolonged use leads to a number of complications developed tolerance to the drug, which forces periodically raise the therapeutic dose to large quantities, they reduce appetite, cause nausea, vomiting, persistent constipation, inhibit the activity of the respiratory center, relax and stun patients, threaten the development of addiction (pronounced cured and hard, painful craving for the drug).
The above tactics to combat the pain of cancer is carried out in all institutions. It is theoretically proved, tested life.
It is inappropriate to begin treatment with drug use. A significant number of patients with pain appear from compression and irritation of the neuro-receptor apparatus of the neighboring tissues is not the tumor itself and the associated inflammatory infiltrate. Analgesic anti-inflammatory, soothing pain, at the same time contribute to the resorption of infiltration - the disappearance of the causes of pain.
Untimely early treatment drug relieves pain but does not contribute to the resorption of infiltration. In these cases, drug use is necessary for a long time, during which time to show up all the negative properties of these funds.
When treatment analgesic anti-inflammatory drugs is ineffective, the pain did not disappear (with the start of treatment or after long-term effective use), oncologists without delay include the therapeutic arsenal of drugs, as other effective measures (analgesic radiotherapy, nerve block, blockade, etc.) to home - not available.
At all stages of pain therapy can be used a combination of analgesics with different levels of aids in order to enhance the analgesic effect and impact on various components of chronic pain. To this end, apart from neuroleptics used hypnotics, antidepressants, corticosteroids, anticonvulsants, bisphosphonates, etc. To monitor for side effects of therapy (including Pain) prescribe laxatives, antiemetics, antispasmodics drugs.
On individual testimony may use symptomatic analgesic radiotherapy and / or chemotherapy, and combinations of medications and medical methods for pain relief such as acupuncture, laser acupuncture, electroneurostimulation, various methods of detoxification.
The urgency of the treatment of pain in cancer patients is dictated by the group IV clinical medical and deontological considerations. Deontological principle is this: if life-saving patient is not always possible, relieve pain, reduce suffering can and must at all times.
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