Opioid treatment for cancer pain

Cancer pain is one that appears in people with cancer. It is an intense and disabling pain that can arise due to the pressure of the tumor itself, the treatment against it or the changes in the immune system, among other causes.

Today, cancer is one of the most important health problems in our environment. In Spain, an estimated 90,000 people die each year from cancer. In addition, of all cancer patients undergoing treatment, it is estimated that almost 40% experience cancer pain.

Unfortunately, in the final stages of cancer, this pain appears in almost 80% of patients. It is a complex situation that is difficult to address. Each person responds in a way to a certain treatment and many of them are very potent drugs.

However, currently, much progress is being made in this field and, little by little, new treatment guidelines appear. In this article we explain the opioid treatment for cancer pain.

What is the treatment of cancer pain?

As we have already mentioned, the treatment of cancer pain must be individualized. That is, it must be specially adapted to each patient, since it depends on the type of cancer that is suffered, on what is causing it and even on the perception of pain of each person.

But nevertheless, There is a general guideline for the treatment of cancer pain depending on its intensity. It is a scale that was determined by the World Health Organization. From less to greater intensity of pain, the following groups of drugs are used:

• Simple analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs): They are used in people who suffer mild pain. The most used are ibuprofen or naproxen.
• For patients suffering from moderate pain, the second step of treatment is weak opioids: In this group we find codeine, tramadol or dihydrocodeine.
• When the pain is very intense, very strong opioids are used: the most used is morphine, but methadone or fentanyl is also used.

In order to classify pain, it is necessary to make a good assessment of the patient. For this, the so-called pain scales are used. On pain scales scores are given to different aspects of pain to classify it somewhere between mild and unbearable.

Normally, in these people, pain is produced by more than one mechanism. Thus, it may become necessary to combine several medications. It is important to be aware that, unfortunately, more than half of the patients end up needing third-step medications.

What are opioid drugs?

Opioid drugs are those that have been obtained from opium and that, in addition, they act on brain receptors called opioid receptors. They are distributed throughout the central and peripheral nervous system.

What these drugs do is join those receptors and curb nerve stimuli. So, by slowing down the stimulus, the transmission of pain is not produced.

But nevertheless, Keep in mind that these medications have numerous side effects. First of all, it is important to note that a large part of opioids, such as morphine, produce dependence.

Similarly, they can increase the feeling of tiredness and weakness. Another risk is that they are associated with a depression of the respiratory system. Thus, you have to be very careful with the dose and should always be used under medical prescription.

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What is the pattern of treatment of cancer pain with opioids?

Second step: weak opioids

As we have already indicated, lThe most used drugs of this step are tramadol and codeine. They can be administered in different ways: for their release to be delayed or for them to act directly. They can also be combined with other drugs, such as NSAIDs.

In the case of codeine, for example, it is usually taken by mouth. At first, the patient can take 30 mg every 4 or 6 hours. However, it is not recommended that you never take more than 60 mg every 4 hours. Nor should it be used in patients who have liver or kidney problems.

Third step of cancer pain: strong opioids

These drugs are reserved for cases where cancer pain is almost intolerable.. The most used is morphine. This is because it can be used in many ways, such as subcutaneously.

Further, Morphine has no ‘analgesic ceiling’. That is, the more dose is administered, the greater its effectiveness. In fact, the dose limit is marked by its side effects, since an overdose can cause death.

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In conclusion

Opioid treatment for cancer pain is complex and should be chosen according to the characteristics of each patient. Thus, It should always be a doctor who chooses it and decides what the guideline should be.