The Investigation Of The Status Of Cancer Pain Treatment And The Significance Of Standardized Treatment

Objective: Through epidemiological investigation, to reflect thetrends of opioids. Three step drug treatment is an important part of thestandard treatment of cancer pain and principles. This study focused onanalysis of clinical efficacy of standardized three step treatment under theguide of "Cancer pain Clinic specification (2011)", and then described theclinical significance of standardized treatment of cancer pain.Methods: This study had surveyed the consumption of inpatientsopioids, in the Fourth Hospital of Hebei Medical University, Departmentof Medical Oncology, including drug name, size, amount, etc, to analyzethe trend in opioid application.This study had followed-up126patients from March2012toDecember2013in the Fourth Hospital of Hebei Medical University,Department of Medical Oncology, diagnosed with cancer pain, who hadbeen given standardized analgesic based on three step analgesic principleunder the" Cancer pain Clinic Specification (2011)"and record the paintreatment process and remission.This study had analyzed the general characteristics of cancer painpatients, including the distribution of disease and pain location, the natureof pain and adverse reactions. This study had analyzed and compared therate of improvement in pain relief during different pain classification,gender and different diseases in NRS score, impact score of life quality,and the number of breakthrough pain. This study had analyzed all patientsenrolled in the overall relief of pain from NRS score, impact score of lifequality, the number of breakthrough pain. This study had explored theinfluencing factors of pain relief. This study had observed clinicalmedication from comparing three ladder drugs, analyzing clinical data of patients with large doses opioid, analyzing clinical data of patients usingtwo ladder drugs.This study analyzed data by the application of SPSS13.0statisticalsoftware. Enumeration data use χ2test. Analyzing the pain relief afterstandardized treatment use repeated measurement date MANOVA.Analyzing the factors affecting pain relief use Logistic regression analysis.Comparing pain relief between the two groups use the t test. P<0.05wasconsidered statistically significant.Results:1The results of epidemiological investigations:1.1Opioid consuming of Department of Medical Oncology in2011-2013included strong opioids such as morphine hydrochloride tablets,morphine needles, oxycodone hydrochloride sustained-release tablets,morphine sulfate sustained-release tablets, fentanyl patches,and weakopioids such as sustained-release tablets of tramadol, tramadol needles,and. The results of surving the opioid consuming show: The totalconsumption of strong opioids increased year by year. Among them, thetablets of morphine hydrochloride, morphine needles, oxycodonehydrochloride sustained-release tablets, fentanyl patches are increasingyear by year; while consumption of morphine sulfate sustained-releasetablets appear fluctuations. Weak opioids tramadol extended releasetablets, tramadol needle consumption declining.1.2Strong opioids proportions: the sustained-release morphine sulfatetablets in2011and2012was first, in2013was second; oxycodonehydrochloride sustained-release tablets constituent ratio increased year byyear,2013ranked first; the constituent ratio of fentanyl patches was fifthin three years.1.3Defined daily dose (DDDs): The sustained-release morphine sulfatetablets DDDs in2011and2012was the first, and in2013was the second.Oxycodone hydrochloride sustained-release tablets increased year by year,in2013was the first. Tramadol needles was the seventh in three years. 2The analyzed results of clinical efficacy of enrolled126patients withcancer pain standardized treatment:2.1Disease of all patients enrolled included lung cancer(48cases,38.0%),gastrointestinal cancer(42cases,33.4%),breast cancer(18cases,14.3%),and other tumors(18cases,14.3%).2.2pain locations of all patients enrolled main included abdominal(38.0%) and chest (31.0%).The nature of pain main included dull(36.5%)and tenderness(35.7%).Significant adverse reactions includednausea(18.9%) and constipation(14.4%).2.3The patients in a different pain rating had statistical difference(χ2=13.403, P=0.001) on the rate of improvement for NRS scoresdecreased after normalized treatment. There was significant difference (χ2=17.348, P=0.000) among patients of different genders, no significantdifference between the different diseases (χ2=5.985, P=0.112).2.4There was no significant difference between different pain rating(χ2=0.140,P=0.932),different genders(χ2=0.061,P=0.585), differentdiseases(χ2=0.088,P=0.993),that the rate of improvement of the quality oflife after standardized treatment.2.5There was no significant difference between different pain rating(χ2=0.916,P=0.633), different genders(χ2=0.168,P=0.682), differentdiseases(χ2=7.560,P=0.056),in the rate of improvement of the reducing ofbreakthrough pain after standardized treatment.2.6Analyzing the pain relief after standardized treatment of all patientsenrolled used repeated measurement date MANOVA. Results: Theaverage NRS score in48-72hours after standardized treatment wasdecreased compared to the average NRS score in24hours beforeadmission. The number of breakthrough pain in72-144hours afteradmission was decreased compared to the number in24hours beforeadmission. The score of the impact of life quality in48-72hoursafter admission was decreased compared to the score in24hours be-fore admission. There were statistically significant (P=0.000). Different pain rating and diseases had little effect on the relief ofpain.2.7By Logistic regression analysis, this study had some results.Anti-tumor treatment (χ2=9.588,P=0.002),and no distant metastasis(χ2=7.846,P=0.005)were independent factors of NRS scores decreased.And they (χ2=8.549,P=0.003)(χ2=8.784,P=0.017)were independentfactors affecting the quality of life score decreased. No distant metastasis(χ2=4.732,P=0.025)was independent factor affecting the number ofoutbreaks pain decreased.2.8This study analyzed the effects of clinical drug by t test. The groupof morphine sulfate sustained-release tablets and the group of applicationoxycodone hydrochloride sustained-release tablets in moderate to severepain has no significant difference in NRS scores decreased after thetreatment(t=-1.556,P=0.123).There was no statistically significant inscores decreased of quality of life(t=0.432, P=0.667).2.9There were17cases of patients in the high-dose opioid using. Therewere9males and8females in these patients. The median age was56years old. The maximum morphine dose was320-1400mg.The medianmaximum daily dose was480mg. Application duration of using high-doseopioid was6-180days, with a median duration of19days. Seven patientshad side effects, including three cases of constipation, two cases ofnausea, two cases of vomiting, one case of lethargy.2.10From the results of surving the application of opioids in MedicalOncology,we can see that two ladder drugs was weakening, but there wasstill a part of patients could be benefited from the two ladder drugs. Theresults of analyzing two ladder patients show that: There were casesenrolled80patients with mild to moderate pain, which applied twostepped drug-treated into patients were23cases. There were13patientswith neuropathic pain.While their hospitalized NRS score was2.153±0.125, admission72hours NRS score was1.782±0.113.Pain was relievedafter two ladder treatment. Conclusions:1Opioid consuming of Department of Medical Oncology in2011-2013was increased year by year.2After normalized treatment, NRS scores,the numbers ofbreakthrough pain,and the score of life quality was improved.Pain isrelieved.3Anti-tumor treatment and no distant metastasis were independentfactors of NRS scores decreased. And they were independent factorsaffecting the quality of life score decreased. No distant metastasis wasindependent factor affecting the number of outbreaks pain decreased.4The effect of morphine sulfate sustained-release tablets andoxycodone hydrochloride sustained-release tablets was quite.5Part of cancer pain patients required large doses of opioids forpain control in clinical,and had no serious adverse reactions.6Although the two-step analgesic drugs have a weakeningtrend,there was still a advantaged crowd.