Period Of's Disease Elimination Analgesic Party In Treatment Of Cancer Pain Of Clinical And Mechanism Studies

Cancer pain is the most common symptoms in cancer patients, patients and their family suffer from psychosomatic and it impact the patient’s quality of life especially for patients with advanced cancer. Western medicine treatment in most country mainly follow the three-step analgesic ladder therapy recommended by WHO, but Chinese traditional medicine plays an important role in external therapy in treatment of cancer pain. Chinese Medicine for external use in the treatment of cancer pain has certain advantages, which is less toxic side effects, no drug dependence, safer and convenient to use.1. Objective:To observe the efficacy treatment of cancer pain using Duan’s Xiaozheng Zhitong Paste, and further improve the diagnostic and treatment of cancer pain using Duan’s Xiaozheng Zhitong Paste, observed it’s effect on rat pain model and explore the analgesic mechanism of action.2. Methods:2.1. Experimental studyEnteric-coated tablets of indomethacin as a positive control, prescriptions with different transdermal agent, formalin induced pain model selected, to observe effects on topical side analgesic effect in rats and c-fos protein expression of Duan’s Xiaozheng Zhitong Paste.2.2Clinical research60cases of clinical admiral eligible hospitalized patients according to a random list, divided into treatment group and control group, the basic treatment in two groups were the three-step analgesic ladder therapy recommended by WHO, the treatment group used Duan’s Xiaozheng Zhitong Paste and the control group used placebo as external therapy for cancer pain. Observed the patient’s pain using NRS score, quality of life, KPS scores and TCM symptoms, such as pain relief efficacy.3. Results:3.1The experimental results3.1.1Analgesic effects Rats pain threshold decreased significantly after rats were given formalin-induced pain, Duan’s Xiaozheng Zhitong Paste group and positive control group (gavage indometacin enteric-coated tablets) shows increasing formalin-induced pain in rats value (P<0.05,▲P<0.01) at various time points when compare with the two models group of DMCO and sesame oil. Duan’s Xiaozheng Zhitong Paste group(DMCO and sesame oil group) improve the formalin-induced pain of the rats pain threshold (P<0.05) in120min compared with positive control group.3.1.2C-fos protein expression effectsThe results:A large number of c-fos immunoreactive neurons from superlayer of rat model spinal cord dorsal foot are observed under light microscope, the results show that, the model group (DMSO, sesame oil) in rat spinal cord dorsal foot area of c-fos positive cells were significantly higher than the blank group, but no significant difference between the two model groups (P>0.05). After treatment, rat’s model c-fos positive cells of the positive control group and two poultice group were significantly lower than the two model group. Rat’s model c-fos positive cells of both model group(DMSO and sesame oil transdermal agent) significantly lower than the positive control group (indomethacin enteric-coated tablets)(P<0.01). Rat’s model c-fos positive cells of model group DMSO were lower than model group sesame oil(P<0.01).3.2Clinical studies:Guang An Men Hospital of China Academy of Traditional Chinese Medicine Oncology department hospitalized patients meet the diagnostic criteria from March2011to March2012(60cases). According to a random list, patients divided into treatment group Duan’s Xiaozheng Zhitong Paste30cases and placebo control group30cases. All patients were under three-step analgesic ladder therapy with different external used medicine (Duan’s Xiaozheng Zhitong Paste and placebo) therapy, and complete14days of basic observation time. The results show that:(1) Two groups compared the pain relief when the treatment complete, Duan’s Xiaozheng Zhitong Paste group total pain relief:86.7%, placebo control group response rate:66.7%, there’s a statistically significant difference (P<0.05).(2) Dose reduction rate compare at the end of the treatment:Duan’s Xiaozheng Zhitong Paste group reduced dose rate:8.93±21.72(%); the placebo group (30cases) drug reduced rate:-13.5±37.40(%), the Duan’s group is better than the placebo group(P<0.05).(3) Chinese medical symptoms improvement compared at the end of treatment:statistically significant differences (P<0.01)when the two groups compared. Duan’s Xiaozheng Zhitong Paste group improvement rate:83.3%, placebo group improvement rate:6.6%.(4) weight change when the treatment ends: the patient’s weight was significantly higher in the Duan’s Xiaozheng Zhitong Paste group compared with placebo group (P<0.01).(5) Changes of Karnofsky score at the end of treatment:Duan’s Xiaozheng Zhitong Paste group (26.7%) can significantly improve the KPS of the patients than in the placebo group (6.7%) there’s a statistically significant difference (P<0.05).(6) comparison of patient’s quality of life after the treatment:there’s a statistically significant difference (P <0.05), Duan’s Xiaozheng Zhitong Paste group improve patient’s quality of life in13cases(43.3%) than the placebo group in six cases (20.0%).4.Conclusion:4.1Experimental Research conclusionDuan’s Xiaozheng Zhitong Paste acts on analgesia and its mechanism is relevant with reduction of c-fos protein expression in the spinal cord.4.2Clinical Research conclusion1. Duan’s Xiaozheng Zhitong Paste group reduce patient’s pain compared with the placebo group2. Duan’s Xiaozheng Zhitong Paste group can significantly reduce the dosage of three ladder analgesic painkillers.3Duan’s Xiaozheng Zhitong Paste external therapy can evidently improve the patient’s clinical symptoms.4Patient’s weight gain more in Duan’s Xiaozheng Zhitong Paste group.5Duan’s Xiaozheng Zhitong Paste group can significantly improve the patient’s Karnofsky score compared with the placebo group.6Patient’s quality of life can be improve by Duan’s Xiaozheng Zhitong Paste group compared with the placebo group.