A case of curly cancer pain in the treatment of intrauterine pump implantation in the cerebellum myelin pool

Pain is common in cancer patients, the World Health Organization (WHO) established the cancer pain treatment norms have been widely accepted, the three-step analgesia principle is based on weak opioid, strong opioid and non-steroidal supplementary drugs as the basis for treatmentEven if the dose of opioids and supplementary drugs is increased in some patients, the pain cannot be effectively alleviatedThe 2017 Multidisciplinary Expert Consensus on intrauterine pain management holds that minimally invasive treatments such as intrauterine pump implantation are recommended for refractory cancer painNarva'ez, etc., can use the cerebellum ementomyl pool in-arm pump where life conditions permitThis paper reports 1 case of patients with refractory cancer in the successful treatment of patients with intrauterine pump implantation in the cerebellum1Case informationpatients, male, 54 years old, after liver cancer, the armpitly lymph nodes, intrapulmonary, intracranial and cervical vertebrae metalyThe patient developed severe pain in the right shoulder back and right arm 3 months ago, with persistent needle-like pain, and the outer hospital used fentanyl transdermal paste 29.4mg, 1 per 72h1 times, external use, tramadol reprieve 100 mg, oral, 1 time/d, analgesic treatment, analgesic effect is not good, 24h outbreak pain more than ten times, rest time digital pain score (nsat scale, NRS) score 5 points, outbreak of pain NRS score 8 pointsconsider the existing drug regimen for poor analgesia, and discontinued the tramadol reprievePatients neuropathic pain diagnosis scale (sympathetic pain, ID-Pain) scale score 3 points, consider combining pathological nerve pain, to be added to the Gabba spray capsule 600 mg, 3 times /d, oral combined analgesia treatmentOn June 10, 2017, the patient was given a 4-point NRS score on the second day of rest, 4 times during the night's outbreak of pain, and 7 points of NRS score, with 10 mg oral rescue treatment of morphine tablets, respectively, due to pain in his right shoulder and back for more than 3 months, and increased his income by 1 week to the First Hospital affiliated with Zhejiang UniversityAfter 1h, the NRS score is 3 pointsInfenteny transdermal paste 29.4mg as a background amount to control pain effect is not good, fentanyl transdermal paste to 42mg, per 72h1 times, external use, while giving dexamethasone injection 5mg, intravenous injection, 1 time/d, amitin tablets 25mg, oral, sleeptime and chlorpyrifos tablets 2mg, oral, sleeping aidthe 7th day of admission of patients still complained of shoulder back and right arm pain is obvious, in Zhejiang University affiliated to the first hospital digital degeneration angiography (digital sub-absorbo angiography, DSA) downward cerebellum esotine ventrinal pump implantThe intra-pump drug is morphine injection 50mg dissolved in 200mL physiological saline, the initial intra-pump parameterise is the background dose (Con) 0mL, the reinforced dose (Bolus) 0.8mL, the lock time is 20min, and the electrocardiogram is administered, and the parameters are gradually adjusted according to the specific pain situationAfter surgery to 8 a.m8 a.mpress Blous 15 times, the number of effective 8 times, after the pressure pain relief is not obvious, adjust the internal pump parameters, Con0.3mL/h, Bolus 1.0mL, while reducing the fentanyl transdermal paste to 33.6 mgBy adjusting the parameters of the intrauterine pump, the NRS score was 1 point when the rest was resting, the NRS score was 4 points when the pain was burst, the number of pain struck was 4 times, and the pain degree of the patient was significantly improvedDue to the patient's advanced tumor, he died of multiple organ failure on the 13th day of admission2Discussionthe latest research shows that the incidence of pain after cancer treatment is 39.3%, during anti-cancer treatment about 55.0% and 66.4% of the pain occurred in the late tumor, metastasis or end-stage, nearly 30% of patients with cancer pain after drug treatment still can not effectively control pain, treatment tolerance, so the tumor itself or treatment-related factors caused by moderate and severe pain, after standardized drug treatment 1 to 2 weeks pain relief and adverse effects of pain is still not satisfied with pain or adverse effects of painfully implantable infusion pump in most cases the drug is pumped into the epidural cavity or cobweb subcavity, and some scholars believe that the intrauterine infusion system must be lower than the neck area, however, more studies have shown that the endothelial myelin intrauterine drug infusion system can effectively treat upper neck and cranial facial painFully implantable infusion pumps are recommended for patients with dying or shorter life expectancy in the 2017 Multidisciplinary Expert Consensus on Intra-Inpatient Pain ManagementIn this case, the patient imaging shows that a number of soft tissue lumps in the neck gap, considered for tumor metastasis, vertebral stenosis, cerebrospinal fluid reflux disorder, so the catheter tip is positioned in the cerebellum symlostalline poolmorphine is one of the drugs recommended by the U.SFood and Drug Administration (FDA) for fully implantable infusion pumps, the intrauterine pump dose recommends a conservative starting dose, because preoperative patientfentanil transdermal paste 42mg analgesic treatment, so the parameters continue to be in the background The dose is set to 0mL/h, the single dose is set to 0.8mL (0.2mg morphine), the study believes that the maximum dose of morphine in the cerebellum eminletal pool is 0.5 mg, and the subsequent internal pump parameters are adjusted according to the patient's pain level and the drug responsethe number of patients without continuous background dose on the 2nd day of surgery and the pain relief after a single dose is not obvious, adjust the intrauterine pump parameters, the continuous background dose 0.3mL/h, the single dose 1.0mL (0.25mg morphine), 42 mg fentanyl dose after expiration reduction to 33.6mg, based on the equivalent opioid dose and related efficacy conversion, is the endophanyl given to the drugIn patients with stable pain, fentanyl transdermal paste 33.6mg expires and then reduces to 25.2 mgAfter the endotheric myelin pool pump implantation patients convertmorphine amount decreased day by day, the pain degree was significantly improved compared with preoperative, the cerebellum myelin intracutomyr pump implantnotnotnot not only reduced the pain level, but also reduced the number of outbreaks of pain In this case, the patient was a patient with end-of-life cancer, and obtained better analgesic effect through the implantation of the drug infusion system in the cerebellum Cerebellum elongation myelin intrauterine administration, small amount, high efficiency, on-demand administration, is the treatment of cervical spine or intracranial high-level metastasis combined with refractory cancer pain is one of the ideal means