| BackgroundPain is the one of the most common symptoms experienced by patients with cancer. It impairs their quality of life and mood. Most pain clinicians believe that the pain management approach of the World Health Organization (WHO) three-step analgesic ladder is applicable to the treatment of patients with cancer. Now this ladder has been shown to provide adequate analgesia to 90% of cancer pain and to more than 75% of terminally ill cancer patients. However, the treatment of cancer pain is complex and often requires combination therapy. In China, acupuncture has been widely accepted in the treatment of cancer pain, and has been widely carried out. However, time of acupuncture analgesia is short, repeated operations is need. So the acupuncture treatment to analgesia requires a better way. Catgut implantation at acupoint is a new form of acupuncture, embedding catgut in the acupoint, and making a long time stimulation. Catgut implantation is widely used in other subjects of pain, so we speculate that catgut implantation at acupoint in the treatment of cancer pain has a role.ObjectivesThe present study aimed to compare therapeutic effects of analgesia induced by catgut implantation plus three-step analgesic ladder and three-step analgesic ladder only, as well as on the quality of life and the impact of depression. MethodsUse a cohort study design principles to establish diagnostic criteria for sample inclusion criteria, exclusion criteria and abscission criteria.60 cases of hospitalized patients were divided into a treatment group(31 cases) and a control group(29 cases). The treatment group were treated with catgut implantation at acupoint plus Three-step Analgesic Ladder, and the control group with Three-step Analgesic Ladder only. The moderate caner pain(NRS:4-6): sustained-release tablet of tramadol (100mg/tablet), a 1 film, Q12H; The severe cancer pain (NRS:7-10):oxycodone hydrochloride controlled release tablets (10mg/tablet), a l film, Q12H or morphine sulfate sustained release tablets (30mg/tablet),1/films, Q12H or transdermal fentany (4.2mg/film), 1 piece 1 time, Q72H. If pain relief is not satisfied, then be based on the degree of pain relief by 25% to 50% increase in dose adjustments, or change another drug until the results were satisfied. Pain intensity was assessed using a 0-10 numerical rating scale every day using the patient's pain daily. Quality of life is assessed using EORCT-QLQ C30 rating scale and Depression state is assessed using SDS rating scale.ResultThe results revealed that were obvious tendency in each group, which the several outcome variables were changed along with period points (P<0.05) There were no differences among the tendencies of each group (P>0.05). The result also showed that the groups are significant different (P=0.010). The result showed the NRS score of treatment group at D2, D3, D4, is lower than the control group(P<0.05). The total pain relief rate of the two group is 21.6% at the third day, and 93.3% at the seventh day. In the third day, the pain relief rate of the treatment group is better than the control group (Z=-1.9751, P=0.0483), and the total effective rate of treatment group is better than the control group (35.5% VS 6.9%, x2=7.2147, P=0.0072). In the seventh day, the pain relief rate and the total effective rate of the both group is no different (90.3% VS 95.8%, x 2= 0.2014, P=0.6536)。Stratified analysis showed that treatment group in the first 3 days can alleviate the severe pain and somatic pain better.Comparing with EORCT scores of the day before treatment, the Functional areas and overall health status of the five subscale scores were improved (P <0.05) in the seventh day. The symptoms of fatigue, pain, insomnia and financial were descended (P<0.05), while constipation score was higher than before (P<0.05). comparing both the treatment and control group at the seventh day, most of the subscale were no different, except the symptom of fatigue, nausea, vomiting and constipation score, the treatment group is smaller than the control group(P<0.05).Comparing with SDS scores of the day before treatment, the score of the seventh day is smaller (61.80±6.12vs55.42±5.07, P=0.000). However the score of the both groups were no different (Z=-0.568, P=0.570)There were no serious adverse reactions in this trial. The major adverse reactions are constipation, nausea, vomiting and loss of appetite. The treatment group had less nausea and vomiting and constipation (P<0.05).Conclusion1. Catgut Implantation at acupoint plus three step analgesic ladder can improve the efficiency of the three step analgesic ladder, particularly reflected in the severe pain group and somatic pain group.2. Catgut Implantation at acupoint can reduce the side effects of the three step analgesic ladder.3. Effective pain relief methods can improve patients'quality of life.4. Most patients with cancer pain have depression, and effective ways to reduce pain would release the depression.Keywordscancer pain; three-step analgesic ladder; Catgut Implantation at acupoint; the quality of life;depression...
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