Painkillers for advanced cancer

Although there are many methods to treat cancer now, once cancer develops to the late stage, it is basically impossible to save the patient. There are not many effective treatments for advanced cancer, and the main focus is on improving the patient's quality of life. The spread of cancer cells will cause the patient to feel pain, so appropriate use of painkillers is needed to relieve the pain. So, what are the painkillers for advanced cancer? Let’s take a closer look below.

Mild pain ~ nonsteroidal anti-inflammatory drugs

Nonsteroidal analgesics have the problem of maximum effective dose (ceiling effect). That is to say, no matter how many types of this type of painkillers are used together, when the dose exceeds a certain level, even increasing the dose will not increase the analgesic effect, but will significantly increase the toxic side effects. Once drug dependence occurs, not only will the pain become more and more severe, but treatment will also become increasingly difficult.

Commonly used drugs: paracetamol, aspirin, diclofenac, adriamycin, ibuprofen, ibuprofen sustained-release capsules, indomethacin (Indomethacin), and phentermine (indomethacin controlled-release tablets), etc.

Aspirin: The most commonly used non-opioid drug, effective for mild to moderate pain, but requires sufficient dosage, at least 0.6g each time, once every 4 hours, and can be used for several months. The main side effects include: allergic reactions, gastrointestinal reactions and effects on coagulation function.

Indomethacin suppository: a non-steroidal anti-inflammatory, antipyretic and analgesic drug with antipyretic, anti-inflammatory and analgesic effects. It is inserted through the anus, 50 mg/time, 2-3 times a day. This drug is easy to use, can reduce gastrointestinal irritation, and has a good effect on patients with mild, moderate and severe cancer pain who have difficulty eating and severe nausea and vomiting.

Moderate pain: weak opioids plus or minus nonsteroidal anti-inflammatory drugs and adjunctive analgesics

Weak opioids also have a ceiling effect.

Commonly used drugs include codeine, bucinnazine, tramadol, Qimanding (tramadol sustained-release tablets), diketoacil (codeine controlled-release tablets), etc.

Bucinnazine: Also known as buprenorphine, it is a psychotropic analgesic used for various pains, such as neuralgia, postoperative pain, low back pain, pain after burning, pain during urination and tumor pain.

Dimethoate: used for moderate pain, acts on the central nervous system to produce analgesic effects, and acts on the medullary cough center to produce antitussive effects. It is well absorbed orally, and the efficacy can be maintained for 12 hours. It is metabolized in the liver and mainly excreted in the kidneys. The main side effects include: constipation, nausea, vomiting, headache, dizziness, and urinary retention.

Severe pain: opioids plus or minus nonsteroidal anti-inflammatory drugs and adjunctive analgesics

Strong opioids have no ceiling effect, but they can produce tolerance, and the dose needs to be increased appropriately to overcome the tolerance phenomenon.

Commonly used drugs include morphine tablets, Mephiladelphine (morphine sustained-release tablets), MSContin (morphine controlled-release tablets, which can be administered rectally), OxyContin, etc. However, pethidine, a commonly used analgesic, is not recommended for controlling chronic pain due to factors such as the high toxicity of its metabolites.

Morphine: A powerful central analgesic with analgesic, sedative, antitussive, respiratory and intestinal motility inhibitory effects. It is used for severe pain and before anesthesia, and its effect can last for 12 hours.

Fentanyl: It is a powerful narcotic analgesic with a rapid onset of analgesic effect but a short duration. It is used for sedation and analgesia before, during, and after anesthesia, and is also used for pain caused by various reasons. The most commonly used one is the long-acting transdermal fentanyl patch, sold under the trade name Durogesic.