cancer pain
Introduction
Introduction to cancer pain Cancer pain generally refers to pain directly caused by tumors, tumor invasion or compression of nerve roots, nerve trunks, plexus or nerves; invasion of brain and spinal cord; tumor invasion of periosteum or bone; invasion of substantial organs and hollow organs Invading or occluding the vasculature; tumors cause local necrosis, ulcers, inflammation, etc.; in these cases can cause severe pain. Pain caused during tumor treatment is also considered to be cancerous pain. basic knowledge The proportion of illness: 50% (cancer patients) Susceptible people: no specific people Mode of infection: non-infectious Complications: abdominal pain, intracranial hypertension syndrome
Cause
Cause of cancer pain
Tumor factors (74%)
(1) tissue destruction: When the tumor invades the pleura, peritoneum or nerve, invading the periosteum or the bone marrow cavity to increase the pressure or even pathological fracture, the patient may have pain, such as bone metastasis, bone pain caused by bone tumor, Lung cancer invading the pleura can cause chest pain, and the tumor of the lung tip can invade the brachial plexus and shoulder and arm pain can occur.
(2) oppression: brain tumor can cause headache and brain neuralgia, neck metastasis of nasopharyngeal carcinoma can oppress the arm nerve plexus or cervical plexus, causing neck, shoulder, arm pain, retroperitoneal tumor compression waist, abdominal nerve plexus, Causes lumbar, abdominal pain, nerve tissue is often oppressed by tumor compression.
(3) Obstruction: When the cavity organ is blocked by the tumor, discomfort may occur. Hemorrhoids may occur when completely blocked, such as stomach, intestine and pancreatic head cancer. In addition, when the axillary lymph node metastasis of breast cancer can be oppressed, it can be oppressed. The axillary lymph and blood vessels cause swelling and pain in the affected limb.
(4) Tension: When the primary and liver metastases grow rapidly, the liver capsule is overstretched and tightened to cause severe pain in the right upper quadrant.
(5) Tumor ulceration, long-term unhealed, infection can cause severe pain.
Other complications (15%)
Pain caused by tumor treatment: This kind of pain is a common complication of cancer treatment, such as radiation neuritis, stomatitis, dermatitis, radiation osteonecrosis, radiotherapy, post-chemotherapy can cause herpes zoster pain, chemotherapy drugs leak out Extravascular extraneous tissue necrosis, chemotherapy-induced embolic phlebitis, toxic peripheral neuritis (Changchun sputum), radical mastectomy, damage to the lymphatic system, can cause swelling and pain in the arm, incision scar after surgery, nerve injury, phantom limb pain .
Other factors (5%)
Hemorrhoids in patients with painful indirect tumors, low body immunity can cause local infection and pain, in addition, prostate, lung, breast, thyroid cancer and other bone metastases cause severe abdominal pain.
Pathogenesis
The occurrence of pain includes three links:
1 receptor;
2 nerve fibers;
3 The central nervous system, the mechanism of cancer pain is not fully understood, it is generally believed that in the bone, soft tissue, lymphatic vessels, blood vessels, visceral mechanical or chemical stimulation activated or sensitive mechanoreceptors and chemoreceptors, passed through A fiber or C fiber To the center, it produces pain.
A fiber is a myelinated nerve fiber with a diameter of 1-4 m. C fiber is a sheath-free nerve fiber with a small diameter of 0.2-1.0 m. A single pain stimulus causes a double sensation, and the two fibers move at the same time. However, the time of impulse to reach the center is different. C fiber is 1.4s slower than A fiber. After stimulation, it feels fast, accurate but not sharp sharp pain, followed by diffuse dull pain. The former is called first. Pain", the latter is called "second pain", the visceral sensation of the afferent pathway is basically the same as the body, but the fiber is 80%, the visceral pain threshold is higher, the expansion, sputum, ischemic tonic contraction Sensitive to chemical stimuli (often causing severe pain, often accompanied by breathing, blood pressure changes, and sweating, piloerection, vomiting, muscle tension, etc.); in addition, the incoming fibers of an organ often pass through several segments The spinal nerve enters the center, and the spinal nerve of one segment can include afferent fibers of several organs. For example, the gastric afferent segment includes the chest 6-9, and the liver, gallbladder, pancreas, spleen, duodenum, etc. Overlap, so the pain is often more diffuse It is difficult to accurately locate, the innervation of the internal organs is double, the painful impulse is mainly transmitted by the sympathetic nerve, the pelvic organ is transmitted by the parasympathetic nerve of the ankle, and the upper part of the trachea and esophagus is transmitted by the cranial nerve (the glossopharyngeal nerve and the vagus nerve). Visceral pain is also involved in pain. It may be that the two pathways of afferent impulses from the internal organs and the body's afferent cells polymerize and interact in the spinal dorsal horn cells of the same node, and then pass through the same conduction pathway to the cerebral cortex; The deviation of the pain location is reflected in the skin area innervated by the spinal nerves. For example, gallbladder pain can be reflected to the right back scapula, and pancreatic pain can be radiated to the lower back.
Radiation therapy can cause radiation neuritis, pain, and it is currently agreed that when large doses (thousands to thousands of rad) of radiation are irradiated, the nervous system, especially neurons, can cause direct damage and can cause secondary nerve damage. The damage is mainly caused by radiation caused by blood circulation and dystrophies. Under the electron microscope, severe vascular endothelium can be seen. The basement membrane of the vascular wall is damaged. Sometimes small blood vessels are blocked or semi-occlusive. Due to poor blood circulation, small blood vessel surrounding glial cells can be caused. Synaptic edema, so that the nutrients transported to the neuronal cells will be insufficient or discontinued, and the edema of the glial cells will press the small blood vessels, causing the microcirculation to become worse, thereby forming a vicious circle, such as treatment is not timely or inappropriate. Can cause neuronal cell death, pain can occur in the process of inflammation, edema and necrosis of nerve fibers. This kind of radiation reaction sometimes has a delayed effect. In a few weeks, inflammation, edema and hemorrhage in the acute phase can gradually Regression, white matter damage can be partially repaired, but necrosis remains, so that it can reappear after 6-8 weeks Symptoms, known as late-stage radioactive necrosis, the greater the dose, the faster the response.
Prevention
Cancer pain prevention
prevention:
Strengthening the prevention and treatment of cancer is the fundamental way to prevent cancer pain.
(1) Chinese medicine oral administration pain relief method.
(2) Chinese medicine external use analgesic method.
1 Chinese medicine partial external hemorrhoids.
2 Chinese medicine painkiller plaster posted.
3 Chinese medicine bags for external use.
4 points for medication to relieve pain, acupoint embedding, acupoint injection, acupuncture and analgesia.
Strengthening the prevention and treatment of cancer is the fundamental way to prevent cancer pain.
Complication
Cancer pain complications Complications abdominal pain intracranial hypertension syndrome
Concurrent abdominal pain or intracranial hypertension.
Symptom
Symptoms of cancer pain Common symptoms Severe painful ear root pain Back pain Intestinal perforation dull pain Intractable pain Outbreak pain Intestinal adhesions nausea
Cancerous visceral pain has the following characteristics:
1 The basic cause of cancerous visceral pain is due to direct erosion or compression of the tumor;
2 pain is often accompanied by pain in other parts;
3 Most of the pain areas are not clear and the scope is wide;
4 pain can often trigger strong autonomic reflexes and skeletal muscle spasms.
When there is pain in the tumor site of a tumor patient or pain in other areas, the first question is to determine whether the pain is caused by the tumor:
1. Breast cancer: Inflammatory reaction in the primary tumor site, local infiltration of the thoracic arm, pain after tumor rupture and ulceration, lymphatic reflux caused by axillary metastasis, surgical injury, lymphatic system can cause hand, arm Swelling pain in the shoulders and back, breast cancer bone metastasis or other organ metastasis can cause pain in the corresponding parts, and high blood calcium caused by bone metastasis can induce abdominal pain.
2. Lung cancer: lung cancer joint pain can occur in the early stage of lung cancer, lung cancer invading the pleura can cause chest pain, bone metastasis causes bone pain, brain metastasis causes headache, lung tip cancer invades or oppresses brachial plexus or sympathetic nerve, may appear Severe shoulder, arm pain and Horner syndrome.
3. Gastrointestinal cancer: gastric cancer can cause stomach pain, gastric or intestinal tumors have liver or abdominal lymphatic metastasis, abdominal and low back pain can occur, local ulcers appear in intestinal tumors, inflammation can have abdominal pain with abnormal stool, intestinal infarction Can cause colic, such as patients with increasing persistent abdominal pain, should first consider the possibility of malignant tumors, gastrointestinal tumors are more common in the elderly, the main symptoms are frequent blood in the stool and anemia, often affecting normal circulatory function , induced angina or intermittent claudication, or intestinal colic due to mesenteric ischemia, intestinal obstruction after intestinal surgery, intestinal adhesions, abdominal pain can also occur.
4. Esophageal cancer: patients with esophageal cancer due to local ulcers, inflammation can occur after sternal burning pain, accompanied by eating barrier, occasionally chest and back pain, esophageal cancer after radiation therapy, radiation damage caused by radiation damage in the chest and back, This pain has no obvious relationship with eating.
5. Brain tumor: long-term headache accompanied by nausea, vomiting or bending when the headache increased due to increased intracranial pressure, should consider the possibility of brain tumors, brain tumors after cerebral edema after radiotherapy, can also cause headache.
6. Others: Cervical and uterine body cancer can cause pain in the perineum and inner thigh. Oral tumors can cause pain in the mouth and roots.
Examine
Cancer pain check
The laboratory tests that need to be done for this disease include: blood routine examination, blood biochemical test, etc., bone biotransmission, blood biochemical examination can find high blood calcium.
In addition, CT, B-ultrasound, radionuclide, MRI, X-ray, etc. help to determine the location and nature of the tumor, and the radionuclide examination can provide a clear diagnosis for bone metastasis earlier.
Diagnosis
Diagnosis of cancer pain
diagnosis
After understanding the medical history and physical examination, it is necessary to use modern instruments to diagnose the cause of cancer pain. It should be noted that the negative result of the test does not mean that the patient has no tumor recurrence or metastasis, and therefore cannot deny that the patient has pain. In short, the tumor The patient's pain first considers the cause of the tumor.
Differential diagnosis
It should be differentiated from non-neoplastic primary pain and needs to be determined based on medical history and imaging examination.
