Investigation And Analysis On The Treatment Of Cancer Pain In Beijing And Clinical Study On The Treatment Of Mild And Moderate Cancer Pain With Bulleyaconitine A

Cancer has become one of the major diseases that endanger human health.Pain is one of the most common symptoms of cancer.Although most of the cancer pain can be alleviated through appropriate treatment,in reality,there are still a large numberr of cancer patients suffering from pain,which has a serious impact on the quality of life of patients.The level of cancer pain treatment worldwide shows a growing trend,but combined with the specific analysis of social and economic levels,the world shows the gap between the rich and the poor in cancer pain control level.The more developed the country,the higher the level of cancer pain control,cancer pain control in developing countries is not optimistic.To measure the level of cancer pain control in China by the per capita annual consumption of morphine,China is in a backward position in the world.There are many possible reasons for inadequate treatment of cancer pain in China.One important problem is that patients are so concerned about the side effects of analgesics that they refuse to take them.In addition to strengthening science popularization and education,we can look for drugs with definite curative effect and fewer side effects from traditional Chinese medicine to provide help.In theory,TCM has a systematic understanding of various pain syndromes,including cancer pain.At present,many research results have been published in both clinical and laboratory studies.Traditional Chinese medicine analgesia treatment resource is rich,has the broad prospect.But there are also some shortcomings:The mechanism research is not deep;The quality of clinical research is poor.Clinical studies need to be carefully designed to provide a high level of evidence based medicine to standardize and promote the clinical application of Chinese medicine in the treatment of cancer pain.STUDY 1:Investigation and research on cancer pain treatment in BeijingObjective:To understand the current situation of analgesics in cancer pain treatment in Beijing,we investigated the concerns,application and side effects of analgesics.Through the comparison with the results of previous investigations,the improvement and existing problems of cancer pain management were understood.Methods:Patients with cancer pain who were treated with opioids and doctors who provided analgesic treatment were selected according to the inclusion criteria for this study.A questionnaire survey was conducted.All questions in the questionnaire were selected from the previous questionnaire used in the 2010 survey(FENPAI4090 study).The questions included patients' general condition,evaluation of pain,pain treatment effect and adverse daug reactions.The questionnaire included doctors'knowledge of cancer pain and their views on analgesics.All respondents filled in the questionnaire by themselves under the unified guidance.The results were compared with those of previous surveys.Results:A total of 270 patients and 161 doctors from 12 hospitals participated in the survey.(1)Fpr patient:oral administration is the main method of opioid treatment;The proportion of patients who had to use analgesics due to unbearable pain was the highest(51.48%);Even though the pain was unbearable,the percentage of patients who refused to use analgesics significantlv increased to 12.22%.mainly due to concerns about adverse reactions to the drugs;The satisfaction of analgesic treatment was 53.7%.which was improved obviously;The original meaning of dissatisfaction is mainly "side effect is big",which is 50%;The three most common side effects were constipation(62.22%).nausea(54.81%)and vomiting(34.07%).(2)For doctors:The most commonly used drugs to treat cancer pain were strong opioids(92.55%),NSAIDS(48.45%).and weak opioids(34.16%);The main factors to be considered in the selection of drugs are the degree of pain(88.2%).type of pain(78.88%),and reliable efficacy(71.43%);The most common type of pain was mixed pain(78.26%);23.6%of doctors had concerns about the use of opioids,mainly about the side effects of the drugs(86.84%).and the fear of addiction was decreasing;The most feared side effect was respiratory depression(50.93%);The most common side effects that affect patient compliance are constipation(54.66%,96.27%);Doctors believe that the most important reason restricting the development of cancer pain treatment is that patients have concerns(82.61%),cumbersome drug management(47.2%).and insufficient training(44.1%).Conclusion:Cancer pain control in Beijing has been improved to a certain extent.The situation of insufficient analgesia is being improved,the standard treatment is being improved,and the satisfaction degree of patients is obviously improved.But there are still some problems.For example,both doctors and patients still have concerns about the use of opioids:Both doctors and patients are concerned about the side effects of opioids,especially the constipation caused by opioids;Currently,stronG opioids and nonsteroidal anti-inflanmatory drugs are the most commonly used types of drugs.So clinical supervision of NSAIDs should be strengthened.STUDY 2:META analysis of the efficacy of Chinese medicine in the treatment of mild to moderate cancer painObjective:In this study,a published randomized controlled clinical study on the application of Chinese medicine alone in the treatment of mild to moderate cancer pain compared with the standard treatment regimen was collected for meta-analysis,with a view to systematically evaluating its efficacy,so as to provide more scientific evidence-based medical evidence for the treatment of mild to moderate cancer pain with Chinese medicine.Methods:The Chinese database was retrieved with "cancer pain or " pain in cancer " combined with "traditional Chinese medicine" or " Chinese medicine” combined with "clinical research" or "RCT" as the search terms:The English database was retrieved with "cancer pain" and "TCM" as retrieval terms.The literature was selected according to inclusion criteria and exclusion criteria,and the data were extracted independently by the two researchers.If there was any disagreement,the third researcher was invited to help solve it;Relevant data of the included literatures were extracted;The quality of the included literature was evaluated by the JADAD scoring scale;Review Manaser5.3 software was used for META analysis.Results:After primary screening,396 Chinese literatures were obtained,and 8 literatures were obtained after secondaty screening.71 English literatures were obtained after primary screening,but were not included after secondary screening?A total of 985 cases were included in 8 randomized controlled clinical studies,including 426 cases in the control group and 559 cases in the experimental group.The JADAD score of the included literature is 1-3.which belongs to the low-quality literature.(1)Changes in pain scores before and after treatment were calculated in 2 articles.In these two articles,the control group was treated with strong opioids(hydrocodone hydrochloride sustained release tablets,morphine sulfate controlled release tablets).and the experimental group was treated with traditional Chinese medicine alone(modified aconitum decoction plus or without,bufalin capsules).The results of random effect model analysis showed that there was no significant difference in the post-treatment pain score between the control group and the experimental group(MD=-0.44,95%C1[-3.30,2.42]),P=0.76.(2)Total analgesic efficiency was calculated in 7 articles.One of the subjects was mild to moderate cancer pain,one was moderate to moderate cancer pain,and one was moderate to severe cancer pain.The other four literatures included mild to moderate cancer pain without pain level requirement.The results of fixed-effect model analysis showed that there was no statistically significant difference in the total effective rate of analgesia between the control group and the experimental group(MD=1.08,95%CI[0.77,1.52]),P=0.66.(3)Four articles treated patients with mild and moderate cancer pain.The control group was composed of non-steroidal anti-inflammatory drugs or weak opioids(tramadol)or a combination of the two(sulfen tablets and aminophenol tablets),while the experimental group was treated by oral Chinese medicine alone(guishen zhitong mixture,tiantoad capsule,cantongping capsule,self-designed anti-cancer and zhitong prescription).The results of fixed-effect model analysis showed that there was no statistically significant difference in the total effective rate of analgesia between the control group and the experimental group(MD=1.11,95%CI[0.75,1.63]),P=0.61.The funnel plot shows that both sides of the graph are basically symmetrical,indicating that the risk of bias is small.Five literatures described that the adverse reactions in the TCM group were lower than those in the control group.Conclusion:Compared with non-steroidal anti-inflammatory drugs and weak opioids,the efficacy of traditional Chinese medicine in the treatment of mild and moderate cancer pain is comparable.It can be seen from the description that there are fewer side effects,but the quality of published literature is low.STUDY 3:A randomized controlled clinical study of bulleyaconitine A in the treatment of mild to moderate cancer painObjective:To evaluate the efficacy and adverse reactions of bulleyaconitine A in the treatment of mild and moderate cancer pain,and to provide evidence-based medical evidence for its application in the treatment of mild and moderate cancer pain.Methods:Single center,block random,positive control,non-inferiority study, According to the admission criteria:(1)Patients with mild cancer pain were selected for baseline assessment and investigation,and were randomly divided into control group and experimental group 1:1.The control group was given ibuprofen sustained-release capsule 0.3 Bid,while the experimental group was given orally bulleyaconitine A tablets 0.4mg Bid.(2)Patients with moderate cancer pain were selected for baseline assessment and investigation,and were randomly divided into control group and experimental group 1:1.The control group was given tramadol sustained-release tablets 0.1q12h orally,and the experimental group was given orally bulleyaconitine A tablets 0.4mg Tid.The observation time was 1 week.Evaluation and investigation will be conducted again after completion.The outcome measures included pain score change,BPI assessment scale,and adverse reactions.Results:Interim summary results analysis,a total of 92 patients were enrolled, including 36 patients with mild cancer pain,56 patients with moderate cancer pain,and 9 patients were not included in the study.(1)There were 18 cases in the control group (1 case out the group)and 18 cases in the experimental group(1 case out the group).The mean ages of the two groups were 0.39 ± 0.47?0.44±0.50.The id-pain scores were 0.39±0.47 and 0.44±0.50,respectively.The mean NRS scores of the two groups before treatment were 1.88±0.90 and 2.30±0.75 respectively.There was no difference between the two groups.After 7 days of treatment,the average NRS scores of the control group and the experimental group were 1.24±0.73 and 1.71±0.67,respectively,both lower than those before treatment(P<0.05).There was no significant difference between the two groups after treatment.In patients with mild cancer pain,there was no difference in the daily mean NRS score between the control group and the experimental group at 7 days of treatment.There was no difference in the proportion of adverse reactions between the control group and the experimental group.(2)There were 28 cases in the control group(3 cases out the group)and 28 cases in the experimental group(4 cases out the group).The mean ages of the two groups were 61,79±9.36.62.46±10.18.and the id-pain scores were 0.43±0.50 and 0.54±10.82.respectively.The mean NRS scores of the two groups before treatment were 3.43± 1.21 and 3.14±1.09.respectively.There was no difference betw een the two groups.After 7 days of treatment,the average NRS scores of the control group and the experimental group were 2.12±0.91 and 2.25±1.36,respectively,both lower than those before treatment(P<0.05).There was no significant difference between the two groups after treatment.During the 7 days of treatment for patients with moderate cancer pain,the pain score of the experimental group on day 2 was higher than that of the control group(P<0.05).and there was no significant difference between the two groups in the remaining 6 days.The incidence of adverse reactions in patients with moderate cancer pain was significantly higher in the control group than in the experimental group(P<0.05).Conclusion:It can be seen that the curative effect and side effect of the treatment of patients with mild cancer pain with bulleyaconitine A were comparable to that of the standard drug ibuprofen sustained-release capsules.Compared with the standard drug tramadol sustained-release tablets,the curative effect of bulleyaconitine A for patients with moderate cancer pain is slightly slower,and the curative effect can be achieved from the third day,but the occurrence of side effects is significantly reduced,which has advantages in weighing the advantages and disadvantages.