Effect Analysis And Advantage Evaluation Of Three Ladder Analgesic Method Combined With TENS In The Treatment Of Moderate And Severe Cancer Pain

Objective The research objects were patients with moderate and severe cancer pain who were accepted 21 days cycles of chemotherapy,by observing variation of pain and opioid medication in patients during pre-treatment,post-treatment and different time point of follow-up period,to evaluate the effect of analgesia by three ladder analgesic method combined with transcuataneous electrical nerve stimulation(TENS);Throuth detecting the immune cell subsets distribution and assessing opioids side effects happened to subjects and their quality of life,then to evaluate the potential advantages of three ladder analgesic method combined with TENS.Methods Based on randomized controlled study design principles,setting up sample diagnosis criteria inclusion criteria,exclusion criteria and abscission criteria.From 146 patients with pain in Zhejiang Cancer Hospital,screening out of the 88 patients meetted to the standard of moderate and severe cancer pain,then randomly divided them into control group(simple three steps analgesic method)46 cases(abscissing 7 cases,it is actually 39cases)and treatment group(three ladder analgesia method conbined with TENS)42 cases(abscissing 1 case,it is actually 41 cases)using the envelope method.Control group only accept three steps analgesic therapy;On the basis of three steps analgesic therapy,treatment group accept TENS therapy in addition.TENS(dilatational wave,2/100 Hz,current strength for patient tolerance degree)was applied bilaterally to HeGu and WaiGuan,ZuSanLi and SanYinJiao for 30min,twice per day(morning for the left side of the two groups of acupoints and afternoon for the right side),5 days per week,stop 2 days,for 3 consecutive weeks.Pre-treatment and post treatment,to evaluate pain in patients with Brief Pain Inventory(BPI)and assess patients’immune function by using flow cytometry instrument to detect immune cell subsets distribution in blood of patients;Pre-treatment,post treatment,1 week follow-up and 2 weeks follow-up,recording patients equivalent dosage of morphine and its growth;Evaluating patients quality of life by the Karnofsy function state scale(KPS)and European health five dimensions scale(EQ-5D);To evaluate the opioid side effects in patients with 3 weeks after the treatment.Results(1)Pain degree:Before treatment,there were no statistical differences in the most severe pain,slightest pain,average pain and the present pain score between control group and treatment group(P>0.05).3 weeks after treatment,compared with pre-treatment,pain index scores were all decreased in two groups,especially the most severe pain score decreased the most significant(P<0.01).(2)Pain influence:Before treatment,REM and WAW index of two groups had no difference(P>0.05);3 weeks after treatment,REM and WAW index present a downtrend compared with pre-treatment,and REM and WAW index of treatment group was obviously lower than control group in the same period(P<0.05).(3)The equivalent morphine consumption:morphine consumption appear a increasing tendency both the treatment group and control group,especially the control group;followed up for 1 week and 2 weeks,opioids consumption growth of treatment group was obviously lower than the control group in the same period(P<0.05).(4)The cellular immunity:Compared with pre-treatment,NK+T cell of the control group is reduced post treatment,while activate CD8+ cells of the treatment group was increased(P<0.05);The rest of the immune cells had no statistical difference(P>0.05).(5)The quality of life:Before treatment,KPS score and EQ-5D score had no difference between the two groups(P>0.05);When post treatment,followed up for 1 week and 2 weeks,KPS score of treatment group is significantly higher than control group in the corresponding period(P<0.01),while EQ-5D score of treatment group followed up for 1 week and 2 weeks significantly higher than the control group in the corresponding period(P<0.01).(6)Opioid side effects:The frequency of nausea and vomiting constipation in treatment group was obviously lower than the control group in the same period(P<0.05);Only control group appeared dizziness and itching,while dysuria,sleepiness and excessive sedation,respiratory depression and delirium of opioid drug side effects did not appear in two groups.Conclusion Analgesic efficacy of three steps analgesic method conbined with TENS for the treatment of patients with moderate and severe cancer pain patients is superior to the simple three steps analgesic method,and it could also reduce the dosage of opioids;Three steps analgesic therapy conbined with TENS is not significant on regulating cellular immune function of patients with moderate and severe cancer pain;Three steps analgesic therapy conbined with TENS could not only improve the quality of life of patients with pain,but also could reduce the occurrence of opioid side effects(such as nausea and vomiting,constipation),and it is likely to be the potential advantages of three steps analgesic method conbined with TENS used for the treatment of cancer pain.