Dealing with pain in cancer patients
Are classified as pain by intensity and by its position to the body, it is where the intensity is classified into two types: acute and chronic or persistent, Pain Acute usually comes in the form of waves or episodes of severe, and lasts for a relatively short time, and an indication of the hurt and damage some tissues and members of the body in some way, and usually depends upon the recovery of these tissues, while the chronic type continues for prolonged periods to some extent, and be moderate in most cases and could grow acute.
In terms of body position Faisnf pain into three types:
Esoteric (Visceral): and the organs vital, as it is not possible in most cases, accurate identification of pain resulting from the hurt tissue is vital esoteric, such as the liver, or set the position exactly, and he describes patients usually Balrgevh or spasticity or Aloclan, pain, throbbing, or painful or acute or Balkadm.
My Body (Somatic): or structural, and is usually associated with bone and muscle, and is concentrated in a specific position, and patients usually describe the pain throbbing, or sharp or compressor, and some describe Baloja, stabbed or like heartburn or Prods.
Nervous (Neuropathic): and is linked to nerve, where results hurt the nerves or the pressure the tumor mass to, and damage to the neural architecture of the central nervous system, or the nerve to Wholesale nerve terminal, and usually described the pain acute or cutter or like heartburn or Prods.
And pain resulting from various causes and different, of course, the most important of the cancer itself and its effects and complications, in addition to the effects of various treatments, and the style depends on the type of tumor and stage, and places like and how he moved from its original position, and these reasons can be summarized in the points the following:
A tissue and throw in a continuous inflation, and affect the tumor pressing on soft tissue or adjacent vital organs or nerves or bone.
The presence of a tumor is blocking the blood vessels, which impedes blood flow.
A blockage of one of the vital organs, or stream or channel in any position of the body.
Transmission of cancer to other sites is the subject of the original inception.
The presence of infection or inflammation.
Side effects of treatments.
They are members and stiffness due to reduced physical activity.
Psychological reactions to disease, such as depression, anxiety or nervous tension.
And, of course, and like any normal child, may suffer a sick child with cancer pain is not linked to cancer, such as dental pain or headaches or stress muscle, which requires determining the type of pain as accurately as possible, to be able to treat effectively, because of the different treatment methods depending on the type pain.
Diagnosis and evaluation of pain
The pain of being a special feeling as the patient himself, can not be assessed from any other person, and every patient feels pain differently than others, and he describes Ptaaberh own (which may be confusing and bewildering at times), and from here should be Parents find a way of understanding with the child cancer patient, according to age and growth of cognitive, especially if aged less than four years, in order to extract sufficient information about the pain, to be investigated and the presence and assessment and identify the various aspects, and it is important to monitor the behavior of the child to know his way to express his feelings of pain, such as facial expressions and how to cry, in addition to the fact that behavioral changes, such as sadness and isolation and inactivity or low activity, which means in turn that the child is in pain, and noted that children sometimes may feel pain without disclosing about it, either for lack of ability or to their confusion and fear, which calls for the need to reassure them and to find appropriate ways of dialoguing.
And should immediately develop a plan for pain management, collecting as much as possible information about it to assess the situation and of course the situation is fact-extraction of information from the patient, and through clinical physical examination.
And pain can be evaluated by finding the answers to the following questions as precisely as possible, and specifically:
What is the severity of pain and unity?
Where the subject of pain, and how to move elsewhere?
What kind of pain in terms of its position, whether it is physical or mystical or nervous?
Dates the emergence of pain and when it began.
What is the duration of pain, and how changes in the pace during the day or night?
What are the factors that increase or reduce the severity of them, or make it get better or worse, such as changing the status of the body or sit or walk?
Is the pain resulting from cancer or for treatments or for other reasons?
Are there side effects of treatments?
And from the usual testing physical different, following the meet the necessary data about the pain, and may be conducted some tests soundtracks, especially x-rays and blood tests when needed, for example, are X-ray if the pain of bone, to determine the extent of the fractures or cracks.
And methods useful largely to assess pain in pediatric patients, the use of standards approximate to describe the unit, such as using a digital scale is included, starting from zero to number five or number ten, which shows each number on the degree of pain than its predecessor, and asked the child determine the severity of the pain, where zero means no pain, and the last number means the most pain imaginable, and can use a scale that contains graphics, the face of various expressions represent different degrees of pain, (such as the drawing below) begin to draw the smiley face, which means no the presence of pain, and then a sketch of the pain a bit, which means the beginning of the pain, then a sketch of the pain is greater than its predecessor, and so on to the sketch of the PAC, which means that there is severe pain, and ask the child to choose from to describe the amount of pain, and are a useful way to deal with children below the age of four years.
On the treatment of pain
Is developing the plan for the treatment of pain associated with cancer in each patient based on several factors, such as age, condition and overall health and medical history of any illness and therapeutic jurisprudence, and the type of tumor, and stage and extent of his transfer from the original position of its inception.
And there are multiple ways to treat pain, including, of course, cancer treatment itself perpetuating a basic pain treatments, oncology various, ranging from therapeutic means between the use of medications for pain and narcotic line of treatment is essential, in addition to treatments do not rely on medications, such as physical therapy, and technology-oriented thinking and methods of distraction and the distraction of thinking, and relaxation techniques and imagery, which may be useful in children above the age of eight and adolescents.
Drug treatments
There is a wide margin of drugs used to treat pain and are include:
Narcotic drugs, or opiates (opioids or narcotics), which is one of the most powerful pain relievers
And of the most effective.
Pain relievers and non-opiate compounds such as acetaminophen (acetaminophen) and non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory - NSAIDs).
NSAIDs help (Adjuvant analgesics) and drugs are used for purposes other than pain management, but they are useful in some cases, from which anti-depressants and steroidal compounds.
And in general is to start using painkillers ordinary vehicles opiates as a first step to treat mild pain and moderate, with the control side effects of potential, especially kidney and stomach, although the pain associated with cancer in most patients and in most cases requires the use of drugs more effective from the beginning, especially when it is severe.
And, of course, are doses specified schema management on a regular basis, and schedule a specific time and throughout the day, and in order to maintain a consistent level of concentration of drug the body to avoid back pain, and may need to also take an additional dose to relieve the pain, which may appear between the dates normal handling.
Pain relievers and other opiate compounds
They include pain relievers moderate, such as acetaminophen (acetaminophen) and NSAIDs non-steroidal such as drug ibuprofen (ibuprofen), and these drugs are especially effective in reducing bone pain and muscle pain surface, and is used as an option given when there is pain of mild or moderate intensity , and sometimes may be added to some types of pain medications to increase the effectiveness of palliative.
It is necessary, of course, follow the recommendations of the doctor carefully when dealing with these drugs, especially taking into account not exceed the ceiling of the daily dose limit, and so as to avoid side effects, which often appear Kedzmmat intestinal varying severity, and may develop certain types of stomach ulcers or bleeding when some cases, in addition to that these drugs slow the process of blood clotting, which requires caution when used in patients with bleeding or clotting illnesses.
Narcotic drugs and opium derivatives
And is most effective in the treatment of pain associated with cancer, and are classified according to their effectiveness in pain relief drugs of strong and weak, Valakakir narcotic weak used to treat pain is moderate, and are usually addressed with a combination in common with some of the sedative non-opiate, which reduce the dosage intake, and of types of the most actively traded real estate codeine (Codeine), hydrocodone and
(Hydrocodone).
While the powerful drugs used to treat acute pain and severe, and has multiple side effects limit the dosage intake in some cases, which affects the effectiveness in the treatment of pain, morphine is (Morphine) of the most heavily traded species, in addition to drugs:
Fentanyl (Fentanyl), and hydromorphone (Hydromorphone), to Iforvanol (Levorphanol), and methadone
(Methadone), and Aoxamorvon (Oxymorphone), and oxycodone (Oxycodone).
On the other hand classified as narcotic drugs to the two main types depending on the speed impact of the drug, and the duration of this effect, drugs, instant and slow, Vonoalla slow give effect during the long period of time and continue the activity for a long time, and therefore the patient receives doses at long intervals to address Light and moderate pain, while the species give immediate effect quickly and lasts a period of activity for a short time only, and are therefore useful in acute pain quickly, and in the treatment of pain, which may appear between the dates of the normal handling of other drugs.
And in this regard it should be noted that there is a series of drug derivatives of opium, which is not recommended for use to treat the pain associated with cancer, such as drug dextropropoxyphene (propoxyphene) and drug Mabreden (meperidine), where Almibreden with the activity of short, requiring repeated doses at frequent intervals , and is broken down into other compounds accumulate body and lead to tremors and muscle twitching, while the drug interferes propoxyphene and functionally interact dangerously with many medicines, and sometimes leads to liver toxicity, in addition to shivering and shivering.
NSAIDs help
Used painkillers to help (Adjuvant analgesics) processors in various other non-pain management, but they are useful in the treatment of some types of pain in certain cases, these drugs include:
Antidepressants (Antidepressants): it was found that some types useful in relieving pain on the nervous system in particular, in addition to treatment for depression.
Anticonvulsants (Anticonvulsants): and is generally used to treat epileptic seizures but they are also useful in the treatment of neuralgia, especially Alnkhozat.
Steroidal compounds: and that can be used to treat bone pain in particular, and pain resulting from a bulge or swelling.
Topical anesthetics (Local anesthetics): and is usually placed on the skin and can be injected into the spinal canal or by the oral route in some cases, and are useful to reduce some types of localized pain.
Dosing and methods of handling
The main objective of pharmaceutical pain management in achieving the best treatment possible, using the least amount of medication and minimal side effects, and it should be noted that the doses required of these drugs vary very significantly between patients, even when there are the same types of pain, generally be initiated in small doses are gradually increased until adequate analgesia is achieved, any amendment of Pharmaceutical calibrate the dose increase or decrease to achieve adequate pain control, and of course should be carefully calibrated doses to avoid the intake of more than necessary.
It is worth mentioning that the treatments the pain was done in the past to give medications as needed and when necessary, which is waiting for the pain to be taking the drugs, allowing, of course, the suffering of the patient to cycles of acute pain, and on the contrary, plans were to modern therapeutic drug delivery schedules time will continue around the clock, to ensure a fixed percentage of the drugs the body throughout the day, which means taking drugs all the time regardless of the patient from feeling pain or not, and may be recommended in some cases take up additional analgesic medication when feeling pain.
On the other hand may be thought by many to be direct injection of drugs is the best way to relieve acute pain, and the fact that the approach through the mouth in the form of tablets and capsules is the best, and recommended for use in most cases, and for ease of handling and the ability of most patients tolerated well, in addition to low cost material.
And the drug is injected through the injection of different course, and is the most heavily traded intravenous isnaads are multiple and can be used or intramuscular injection under the skin, and if that is not appropriate when you need to repeat doses, as medicines can be injected into the cerebrospinal fluid using the NA injection (intrathecal), or injected into the space between the bones and the spinal canal (epidural), and when you use these methods for long periods can be used pumps are small, are implanted under the skin to inject the drug continuously.
And methods of approach used also:
Patches of skin (skin patch): and is to Soqat like bandages are installed on the skin, and you publish the medication through the skin slowly and continuously for periods ranging from two to three days, and this method is good to avoid nausea and vomiting Ktathirat side effects in some patients, and is the drug fentanyl (fentanyl) of more drugs addressed in this way.
Rectal suppositories (Rectal suppositories): where the drugs dissolve rectal and absorbed by the body.
Pumps, portable: You can use small pumps mounted containing drugs and pre-programmed, and is updated and connected to a needle installed one of the veins or tool catheter planted the body, so that the patient use his own when needed, as pushing a button injection, whereupon the pump injects dose of pre-prepared and programmed by scheduling specific (and not beyond it, even the button was pressed repeatedly), and this method use in adolescents and adults, of course, and is especially useful when there are difficulties in the patient in taking the pill, or non-effectiveness of drug intake for through the mouth in the treatment of pain.
Side effects of pain management drugs
Vary the side effects of narcotic drugs and vary from patient to patient, and if they do not generally appear sharp and can be controlled Bamadaafadtha easily, and stop in three days in most cases, and from normal to feel most of the patients sleepy and idle when dealing with drug-time First, and to reduce this viewer will be started in small doses and then gradually calibrated to reach the maximum possible point of pain.
And some patients experience nausea is accompanied by vomiting, which is not of the usual symptoms, and there are many drugs for nausea in use and effective in the treatment of this gallery, and it should be noted that the nausea when accompanied by the appearance of skin rash or itching is a sign of allergy medication and the patient is to stop taking the drug used in the case, while it may show symptoms of itching, and if they are rare and can be treated with some medicines.
Perhaps the most important side effect of drugs opiates is the occurrence of constipation, and that appears to varying degrees in most patients and usually begins within a few days and may continue throughout the period of receiving these drugs, and may be so severe as to require accommodation the clinic to receive appropriate treatment, which required to take appropriate measures to avoid it as much as possible, such as increased rates of ischemic and body to eat more of fluids, and increase the rate of fiber feeding system and to carry out light physical exercise, in addition to the use of laxatives and stool softeners as recommended by the appropriate physician.
On the other hand, and that it rarely may cause some types of these drugs, the occurrence of delirium, and the appearance of symptoms such as mental confusion, and confusion of thinking and hallucinations, and has a sense of place and time, which may require the need to change the drug user, or reducing the dosage intake and add housing assistant, and should of course notify the medical team at the Note of such symptoms.
Endurance drug (medicine tolerance)
In some cases, and over time requires some patients to deal with higher doses of drugs to treat pain effectively, and may be due to increased rates of pain, or the development of the so-called catering drug, as accustomed to the body to the drug user, and no longer doses received effective in the placement of pain, as is the case at the beginning of treatment, and noted that the endurance drug to the drug does not arise in many patients, and that happens, it is usually in small amounts to increase doses or change the drug user.
It should be noted that it is often confused with the endurance drug and addiction, and are two different things, Valthml pharmacological arise with the extension of the time period for the use of drugs, and an indication of the body's need for more of the amount of medicine used to achieve the same level of pain, and this need to increasing the dose of the drug is not in the signs of addiction, and it can be compared with some of the change overtaking the need for insulin in patients with diabetes, as the need to change drug treatment in patients with cancer pain.
Stop taking drugs
Cause a sudden stop and drop out of drug use drugs on the emergence of many of the symptoms, such as excessive sweating, diarrhea and symptoms similar to a cold cold, so it is to stop receiving these drugs gradually to avoid such symptoms, which usually ended within days or few weeks, and processed in various ways, and usually taught the best way to stop a case by case basis.
Other processors
Oncology treatments
Help brachytherapy or for the entire body to increase the effectiveness of treatments of pain different, its impact directly on the tissues of tumors and reduced their size, and is particularly useful to relieve pain caused by the transmission of cancer to the bone, also may use chemotherapy for the same purpose, ie to reduce the size of the tumor causing the pain .
While using surgery to remove part of the tumor tissue, or eradicate it completely, thus easing and live pain directly, in addition to alleviate complications and symptoms caused by the presence of disabilities or blockages arising from inflation, the tumor mass, such as a blockage of the intestines, or resulting from the pressure of the tumor to the members vital and nearby tissues, such as the lung or the spinal cord.
Disable the nerves (nerve blocking)
The process of disabling the nerves by injecting a local anesthetic (plus the drug steroid usually), in the nerve or nerve root or spinal cord, and use this method when there is pain is not processed and does not respond to other treatments, or when the appearance of side effects is a potential for drug treatment pain, and may be in some cases cut a nerve surgically to prevent pain.
On the other hand can take advantage of the nerves in a way to disable the source of pain, and to predict the extent of its response to long-term treatments, in addition to the prevention of pain after medical procedures.
Non-drug treatments
There are many techniques and non-drug therapies useful in alleviating the pain, and can be used in parallel with drug treatment of pain, or without, in some cases, and is included physiotherapy, heat treatment and cold, and mental and psychological treatments such as relaxation techniques and thinking directed and hypnosis, and in the following paragraphs About these treatments:
Natural and physical treatments
Can alleviate the pain of muscles and bones using the heat in places of pain, put hot compresses or the like, or using cold compresses or ice put cold.
According to massage techniques and massage and pressure consistent and monotone on the subject of pain in the pain relief caused by muscle spasm, or fall, and to relax and reduce nervous tension.
According to physical exercises to strengthen weak muscles and loosen stiff joints and activate the pulse.
Which helps ease the pressure parts of the body and improve blood circulation and relieve pain, that is determined appropriate postures of the body as a way to sit or lie down, and change the status of the patient and the other from time to time, determine the range of motion and pain with placements.
The use of IT electrical activation of nerves through the skin (Transcutaneous electric nerve stimulation), and is a technology that uses a weak electrical current frequency, is connected to the skin where the subject of pain, and a soothing sense of power generation and reduce some types of pain.
The use of Chinese acupuncture, inserts fine needles at specific points placements certain body to control pain.
Mental and behavioral treatments
Directed thinking
Targeting techniques thinking-oriented inventory of thinking the patient when there is pain in the matter specific, so indulge it completely and in all senses, in order to divert his mind from the pain, and one of the best ways to guide the thinking of sick children are reading aloud of the Koran, and an examination of the child to read himself and thus protect it from the Koran, and revised in the case when there are errors to the provisions of recitation, and urged him to return and correction, Fterkisah mental will turn to the need to memorize what keeps it and proficiency in reading, which limit the thinking Qur'an and distracting him from feeling pain, in addition to the reading Holy Quran will be supported by psychological and calm thoughts, and denies him the negative thoughts and reduce pain.
Relaxation exercises
Is the relaxation exercises simple, such as exercise deep breathing and monotonous, and exercise pandiculation and relax repeatedly, it is useful way to alleviate the pain, and can teach the patient methods of performance by the physiotherapists, and are useful when the focus is mental is weak because of the presence of pain or fatigue or anxiety, as well as relieve some types of pain and eliminate muscle tension, and preparedness for help when a medical procedure is painful.
Guided imagery
And is a way of directing the mind to create perceptions of mental imaginary and multiple, such as to imagine heaven and that is in them of the joys or the location of a delightful and beloved or peaceful views of the same, or sounds nice or scents or good feelings, focus on the perceptions of imaginary transforms the mind of the patient away from the think of the pain, and changes Attenbaha in another direction, and is a good way to help children and adolescents to feel as if they actually enter the imaginary worlds, and thus reduce their sense of pain and give them a sense of control.
Hypnosis (hypnosis)
Hypnosis is a state of mental focus intense between sleep and wakefulness, and when you relax a person be more receptive to suggestion and therefore can be turned off and the consciousness of pain, as a specialist inpatient direct the patient to enter into a state of awareness on subjects as far away from the pain, which helped him to Control painful sensations, and hypnosis techniques used effectively to relieve pain, especially when painful medical procedures, and can be used to help relax or in conjunction with the mental and behavioral treatments other.
Distraction (Distraction)
The use of methods of distraction and the distraction of thinking of useful tools significantly reduce pain in children, where it is spent thinking about pain, or negative emotions associated with pain, and directed towards other things, whether gradually or suddenly, may be things that distract the infant color and animated or singing to them, and can distract the older reading stories or watching videos, or raising the personal interests, or intellectual games such as optical or electronic games and video games, etc., can also teach the child how to change the negative thoughts that his mind and ideas quickly other positive, and the important thing is to know what could be interesting for the child to distract his mind from the pain and alter the Zhnih and psychology.
Address the pain when medical procedures
Because of the pain associated with many medical procedures of diagnostic and therapeutic, such as extraction of bone marrow or lumbar puncture, these actions represent one of the biggest fears of children when dealing with tumors, and targeted management of pain in such procedures to reduce suffering to a minimum, and remove the fears of the child with completion of medical procedure to the fullest, and is, of course, using drugs, where drug use topical and narcotic drugs, short-term, or the use of general anesthesia and drugs, sleeping pills to numb the child before the direct process, in addition to the use of roads mental and psychological, such as thinking-oriented and methods of relaxation and distraction.
And in this regard it is useful to note the need to teach the child, and give sufficient information about the medical procedure to be ahead of schedule well in advance, in order to psychologically prepared and remove his fears, as the unknown always holds a greater concern than if it is known, as may be built by one of the fantasies around him and useful ways for this:
Explain every step of the procedure in detail and use of medical images or graphics.