Study On The Analgesic Effect Of Chinese Medicine Combined With Low-dose Strong Opium On Moderate Cancer Pain

Objective: To analyze the prescription characteristics of traditional Chinese medicine(TCM)in treating cancer pain,to study the mechanism of action of "Dannanxing",a representative Chinese medicine for cancer pain,and to determine whether low-dose strong opiates are superior to traditional second-step drugs in the treatment of moderate cancer pain,and to further explore the synergistic effect of low-dose strong opiates combined with TCM in the treatment of cancer pain.Material and method:1.Prescription analysis of cancer combined with cancer pain.The patients with cancer pain of lung cancer who were hospitalized in the Oncology Department of Liaoning University of Traditional Chinese Medicine from December 2015 to December 2017 were selected.Each patient was randomly included in one prescription.The number of medication flavor,high frequency drugs,medicinal properties,meridian tropism,efficacy,dosage,toxic drugs and TCM syndrome differentiation were counted.The high frequency drugs used in prescriptions were clustered and analyzed.According to the analysis results,the rules of prescription composition and the application characteristics of TCM with different pain scores were summarized.2.Experimental study on analgesic effect of Arisaema.Healthy male KM mice were selected with a weight of 20 + 2g.The mice were divided into three groups: model group,positive control group and Dannanxing group.The positive control group was given aspirin 0.2g/kg,while the Dannanxing group was given Dannanxing 7.8g/kg,once a day for 5 days.In anti-inflammatory experiment,the difference between the two ear pieces was taken as the swelling degree,and the swelling rate and inhibition rate were calculated.In hot plate experiment,the time of licking feet was observed,and the threshold raising rate was calculated.In torsion experiment,the number of torsion was observed,and the analgesic rate was calculated.3.A controlled study of Chinese medicine combined with opioids in the treatment of moderate cancer pain.1)subjects: moderate cancer pain patients who had not received opiatetherapy before treatment(NRS4-6).2)Grouping and administration: All patients were randomly divided into low-dose strong opium group(referred to as the Opium group)and traditional second-step group(referred to as the second-step group).The pain was controlled by oral administration of low-dose strong opioids and second-step drugs.The patients in the two groups were titrated gradually until NRS < 3,and continued to use drugs until the end of observation.Patients in the two ladder group were replaced with Morphine Hydrochloride Tablets until the NRS was less than 3.Opioid patients who exceeded the low dose limit still had NRS > 3 points were given the original analgesic dosage until NRS < 3.According to the situation of oral Chinese medicine,the two groups of patients were divided into two groups:the integrated treatment group(referred to as the integrated group)and the simple western medicine treatment group(referred to as the western medicine group).In combination group,traditional Chinese medicine decoction was added on the basis of opioid drugs,while only oral opioid analgesic treatment was given in western medicine alone.For the possible adverse reactions,the western medicine group was treated with western medicine for symptomatic treatment or observation.3)observe time: 28 days,every 7 days 1 time nodes,each time node carries on the data statistics.4)Observed indicators: The efficacy indicators were measured by NRS.The degree of pain relief was divided into 0-4 degrees(0 degree was not alleviated,4 degree was completely alleviated);the rate of pain relief was =(mild alleviation + moderate alleviation + obvious alleviation + complete alleviation)/ the total number of adverse reactions was * 100%.The Guidelines for Clinical Research of New Chinese Medicine(Trial Implementation)scored 0-3 points from light to heavy;the quality of life scored 0-100 points according to KPS;and the general symptom score was 0-10 points according to the severity of symptoms using the Edmonton Symptom Assessment Scale(ESAS).Results:1.Prescription analysis of cancer pain treatment: 273 prescriptions for cancer pain of lung cancer were collected,and each prescription ranged from 12 to 36 flavors,with an average of24 flavors.There are 158 kinds of drugs.1)Drug attributes and dose analysis results: the frequency of use of roasted licorice was the highest;the distribution of medicinal properties,the types of cold drugs were the most,followed by warm,calm,cool and hot drugs;thedistribution of medicinal taste: the types and frequency of use of sweet drugs were the most,the rest were bitter,bitter,acid and salty in turn;the distribution of efficacy: 142 kinds of medicinal efficacy were divided into 15 categories.In addition to purgative drugs,87 of the other 14 effective drugs used exceeded the theoretical maximum dosage,and 8 toxic drugs were more toxic than the theoretical maximum dosage.Small,5 drugs exceed the theoretical use of measurement.2)Drug cluster analysis results: The first 24 high-frequency drugs were classified into 9 drugs by systematic cluster analysis.The nine drugs were divided into 4groups,including: base,anti-cancer,analgesic and symptomatic improvement.The highest frequency of the base tonic was Pseudostellaria heterophylla,and the highest frequency of anti-cancer drugs was Scutellaria barbata.The highest frequency of pain Chinese medicine was bile,and the highest frequency of symptomatic treatment was bitter almond.The number of drugs used in each group of patients with different NRS scores was analyzed.The average number of medicines used in moderate cancer pain was the most,the number of medicines used in mild pain was the least,and the number of medicines used in mild pain and moderate and severe pain was statistically different(p < 0.05).The most medicines used to control cancer pain were 7.13 + 0.76,and the most medicines used to relieve pain were moderate pain.Pain group had 4.05(+0.55)flavors,while severe pain group had 12.15(+4.21)flavors,which were the most frequently used drugs to improve symptoms(p < 0.05).2 2.the results of analgesic pharmacodynamics experiment of gall star were as follows:Compared with the model group,the results of aspirin group and cholangnanxing group after administration showed that the ear swelling degree of mice in the anti-inflammatory experiment was the same in the two groups(13.30(+1.35 mg)and 11.08(+1.00 mg),P >0.05),significantly less than that in the model group(p < 0.05),the swelling inhibition rate was 50.49% and 40.59%,respectively,and the pain threshold of hot plate experiment was the same in the two groups(20.10(+3.57 s).The number of writhing in aspirin group was less than that in cholinergic group(15.11 +1.83 vs 20.08 +2.15 times,P < 0.05),but it was significantly lower than that in model group(p < 0.05),and the reduction rate/analgesic rate was 53.5%,respectively..74% and 38.52%.3 3.a controlled study of Chinese medicine combined with strong opioids in the treatment ofmoderate cancer pain:1)Compared with the second-step group(136 cases),the pain relief rate(88.89% vs.88.24%),the pain score(2.02±1.23 vs.2.6±1.17)the number of outbreaks of pain(1.30±0.59 vs.1.74±0.88)and the improvement of KPS(68.5±8.55 vs.64.12±9.58)in the Opium group were better than those in the second-step group(p < 0.05).The number of patients with NRS > 3scores in opium group was less than that in the second-step group(p < 0.05).The patients with NRS > 3 scores in opium group began to be treated on the 21 st day.By the end of the experiment,10 patients in opium group had been upgraded to the third-step treatment,accounting for 7.9% of the total number,accounting for 15.38% of the patients with NRS > 3scores,and the patients with NRS > 3 scores in the second-step group had risen from 14 days.At the end of the trial,28 patients were upgraded to a three-step treatment,accounting for20.59% of the total number and 34.15% of the NRS > 3 scores.The pain score in the opioid group was lower than that in the second-step treatment group(p < 0.05),and the remission rate was better than that in the second-step treatment group(p < 0.05).In terms of fatigue,shortness of breath,pain and self-perception,the low-dose strong opium group was significantly better than the second-step group(p < 0.05);the main adverse reactions of the two groups were similar,mainly constipation,nausea,vomiting,vertigo,sleepiness,etc.The degree of vomiting in the Opium group was significantly higher than that in the second-step group(p < 0.05),and there was no significant difference between the two groups.But after treatment,the degree of adverse reactions was significantly reduced(P < 0.05).2)stratified study: compared with 63 patients in the Opium group and 63 patients in the western medicine group,the pain relief degree,pain relief rate,dosage,number of outbreaks of pain and KPS score in the combined group were better than those in the western medicine group(p < 0.05).The combination group was significantly better than the western medicine group in improving fatigue,loss of appetite,pain,anxiety and self-perception(p < 0.05).The curative effect of combined group on constipation was significantly better than that of Western medicine group(P < 0.05).3)Relevance analysis: The patients' gender,age,type of disease,metastasis,western medicine,TCM syndrome differentiation and other indicators were analyzed with regression with the number of analgesic drug application groups.The pain score at the time of admission was related to gender(female),type of disease(gynecological cancer)and TCMsyndrome differentiation(deficiency syndrome);pain relief.The factors related to the rate of dissolution were Western Medicine(low dose opiate)and TCM syndrome differentiation(empirical).4)Drug analysis: 15 kinds of analgesic traditional Chinese medicines(formulas)were divided into four groups.The frequency of empirical medication was from high to low as Qi-promoting drugs,analgesic drugs,blood-activating drugs and deficiency-tonifying drugs,and the most frequent was Bupleurum chinense.Deficiency syndrome is analgesic effective medicine,reinforcing deficiency medicine and Qi regulating drug.Regardless of syndrome differentiation,gall has a large proportion in analgesic Chinese medicine.There was a positive correlation between the number of Chinese herbal medicine groups and morphine use(p < 0.05),but no correlation with pain relief rate and pain score at admission(p > 0.05).Conclusion:1.For patients with lung cancer who have cancer pain,the prescription of traditional Chinese medicine for treatment includes base prescription,anti-tumor traditional Chinese medicine,pain relief traditional Chinese medicine and improvement of symptoms of traditional Chinese medicine,and the drug dosage is adjusted according to patients' NRS score and general symptoms to achieve better pain relief effect and guide clinical practice.2.Asacommonly used analgesic in clinical studies,ARISAEMA CUM BILE has shown good anti-inflammatory and analgesic effects,and also confirmed its principle and effectiveness in the analgesic prescription as the main analgesic effect,laying a pharmacodynamic basis for the treatment of cancer pain with traditional Chinese medicine.3.Compared with traditional second-step analgesic drugs,low-dose and high-strength opioids showed more obvious analgesic effect and longer analgesic time,better improvement of general condition and symptoms,and better analgesic effect in the elderly population.Although the side effects of low-dose and high-strength opioids were more than those of traditional second-order drugs,they were significantly improved after combined treatment with traditional Chinese and western medicine.4.In the treatment of moderate cancer pain with low-dose opioid,traditional Chinese medicine can increase the analgesic effect,prolong the analgesic time,alleviate side effects,and slow down the increase rate of dose,providing a synergistic effect for the smooth replacement of traditional second-step drugs.5.TCM can also treat cancer pain during the treatment of malignant tumors,providing another clinical evidence for TCM to improve the general state and quality of life of tumor patients.