Pain therapy

It is important for patients to know that the doctors treating them cannot automatically draw conclusions about the pain on the basis of medical examinations such as X-rays or computer tomographies. A tumour does not necessarily hurt wherever it is found. Rather, the patient needs to tell the doctor whether there is pain and how severe it is. Patients should also not be afraid that their doctors might be distracted from the important goal of successful cancer treatment by a complaint about pain.

The components of successful treatment of pain in tumour diseases include tumour-influencing treatments such as radiotherapy. This is particularly important for bone pain, one of the most common causes of cancer-related pain. Chemotherapy and surgery can also be useful and important for treating pain. On the other hand, pain treatment is primarily carried out with medication, which is administered according to schedule and in sufficient doses according to the World Health Organisation's (WHO) step-by-step scheme.

Additional pain treatment options include physiotherapy and other forms of physical therapy, so-called counter-stimulation procedures such as the application of cold and heat and, in individual cases, neurosurgical pain treatment procedures such as pain pumps. Psychological treatment methods such as relaxation exercises can also be a valuable aid in controlling pain.

Due to its outstanding importance, the World Health Organisation's (WHO) stage scheme should be presented in more detail. It was published almost 20 years ago based on many years of experience by experts, particularly in English palliative medicine. In the meantime, it has proved to be a very effective and successful treatment rule for the vast majority of those affected.

Medication is administered in 3 stages according to the patient's pain. For mild to moderately severe pain, simple painkillers are used first, which include drugs with an aspirin-like effect such as paracetamol or rheumatism painkillers. It is important to know that these medications should generally be taken at fixed intervals according to their duration of action in order to achieve an even level of active ingredients in the body.

If the pain becomes more severe and a simple painkiller is no longer sufficient, a so-called weak morphine-like medication is added in the second stage. In Germany, tramadol or tilidine preparations, for example, are very common medications. Here too, these drugs should be taken at regular intervals according to their duration of action.

If the level 2 medication is no longer sufficient, it is replaced with a strong morphine. The strong morphines include morphine itself, for example, which is still very important in cancer pain therapy. However, there are also other strong morphines that are suitable for the treatment of severe tumour-related pain. These include, for example, the frequently used pain patches. It is important to know that the necessary dose of morphine can be different for each patient. It must therefore be found individually for each patient and often adjusted over time. If attacks of pain occur in addition to the basic pain, it is possible to take additional doses of morphine. As morphines unfortunately also have undesirable effects, additional medication must be taken, for example for nausea and constipation. In addition to the active ingredients mentioned, it may be necessary to take other medications for nerve pain. These include - which may initially surprise some patients - so-called anti-epileptic drugs and antidepressants, i.e. drugs that were originally developed for the treatment of seizures and depression. These drugs must also be taken at regular intervals according to a fixed schedule. The aim of pain treatment is to reduce the pain to a tolerable level. Complete freedom from pain can sometimes be achieved, but not in all cases. However, what is more important for patients is often the experience of getting their pain under control again and being able to do something themselves if the pain intensifies again or if pain attacks occur.

As a rule, good pain relief improves the patient's sense of well-being. Those affected can become more active again, their night's sleep becomes more restful and their mood improves. Many people who are initially reluctant to take morphine regularly are able to overcome these fears once they have experienced successful treatment. Unfortunately, the common concern that prolonged use of morphine preparations could lead to addiction is still unfounded. There is also no real cause for concern that the strong morphines could quickly lose their effect or be harmful in the fight against cancer. Nevertheless, even today there are still patients for whom such fears are the reason why they would rather endure pain than take advantage of effective pain treatment.

In this respect, patients (and doctors!) still need to be encouraged to recognise the value and necessity of good pain therapy as part of comprehensive cancer treatment.