How do we treat all that pain?
Well, we have several approaches: pharmacology, radiotherapy, surgery and chemotherapy. Let’s really look at each therapeutic tool. In which cases is it indicated? Are we talking about what drugs are to combat cancer pain, is it being on the market or let’s say therapeutic arsenal in this area are drugs enough? There are few drugs. There is a large arsenal and they are perfectly sufficient. In addition, there are drugs that have little potency and drugs that have a lot of potency, so we have a very wide range to choose from. Pain is a symptom that we have to treat, but each pain is individual and each pain is of a certain intensity. Therefore, having drugs that cover low intensity pain and that have few side effects, and having drugs that cover very intense pain and that have large side effects, allow us not to have to make one kind of coffee for everyone.
The World Health Organization has done this with the classification of pain relievers. It is to make a staircase, a staircase with three or almost four floors. Nonsteroidal anti-inflammatory drugs would be on the lowest floor. The paradigm, aspirin, paracetamol, would be drugs that remove pain, that remove mild pain and that do not have relatively many side effects. We would climb the step when the intensity of the pain will demand it and then we will cover that pain. Analgesics. The second step would be the weak opioids, like codeine, which is normally used as a cough syrup, or tramadol, the pain, which is also a good painkiller, but already has more side effects. And if we can’t treat that pain because we can’t cancel it With this second step we will go up to the third step, which is that of major opioids, that of the famous morphine, which we are going to talk about at length in this program and which are very good drugs, very powerful from an analgesic point of view They do not have a therapeutic ceiling, that is, they can be used by increasing the dose whatever we want and that they are indicated for that very strong type of pain that is not controlled by others.
In relation to the elderly, it is possible, he has commented. Before I am going to ask you three questions that are three great myths directly related to morphine. Many cancer patients and their families are afraid to start this drug because they believe that it may cause addiction and that the person may become a drug addict. It is true?
Yes, there is a lot of myth about morphine and one of them is the one you mention, that of administering morphine. Is it going to make us a drug addict? That is not true. Morphine is actually an opium and older, like those used by drug addicts, now called injecting drug users to get high. But there is a radical difference between the patient with cancer pain and the person who voluntarily decides to take drugs. The one who takes drugs does it to escape from the world around him and to have another series of sensations, the one who is going to consume opium and when he is older, either morphine or any of the others to treat pain.
He has pain and the drug will counteract that pain. Therefore, there is no risk of addiction because you are not looking for anything pleasant. For this reason, when we are going to suspend the morphine, because the pain has disappeared, we will not have any problem of having to enter a detoxification unit or anything similar. What we will have to do, as with other medications, for example, corticosteroids or benzodiazepines, is to make a descending pattern, gradually taking the medication away.
By taking it off, little by little we get used to it and getting used to it. When we stop the morphine, it won’t do any withdrawal symptoms or anything weird. Another myth that we are going to use as a second question would be the cancer patient can use morphine to commit suicide?
Much is also said about the subject that the patient will use the morphine that he prescribes to commit suicide. It is also not true. A reading has not really been described in the medical literature and no cancer patient with a prescribed major opioid, be it morphine or any of the others we are talking about, who has used them to overdose and therefore commit suicide. Moreover, suicide is more frequent among oncological patients within, which is a patient who does not commit suicide more than the patient of any other pathologies, but it is more frequent that they commit suicide if the pain they have is not controlled and leads to despair, that if thanks to the use of morphisms and all the major analgesics we can get rid of that pain that is really what is reducing your quality of life.
The third question would be related to. The other big myth is that morphine is only given to dying patients and patients are scared. It is also said a lot that if a patient is given morphine, he is already dying, because it is also another myth and therefore another falsehood. Morphine is a very powerful analgesic and therefore morphine and major opioids, therefore, are indicated in very strong pain. It is a linear relationship, intensity of pain, intensity of analgesia that we have a very strong pain. For example, a herniated disc. A patient with a herniated disc who is waiting for surgery.
Morphine is put on this patient or we put the fentanyl patch on him, which when he gets older we put any major analgesic, we take away that pain intensity, it is very powerful and he is a patient who has no expectation of dying. Therefore, the morphine association has to be broken a bit. Same with death.
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