Traditional Chinese Medicine for Cancer Pain

Wang Jy, Xu L, Zhing Rx, Lao Lx. Zhong Xi Yi Jie He Xue Bao. 2011; 9(2): 129-34.
Abstract: Pain is one of the common symptoms of cancer which seriously affects the quality of life of the patients. Cancer pain is mainly treated with the three-step method, biological therapy or nerve block therapy based on antitumor therapy. However, up to 50 percent of patients with cancer-related pain do not receive adequate pain relief, affecting their physical and psychological well-being, and leading to a lower quality of life for the patient after conventional treatment. Clinical observation suggests that traditional Chinese medicine may alleviate cancer-related pain either by oral administration, topical administration, acupuncture or other means with continuing non-addictive and non-drug-resistant qualities. However, scientific evaluation of the efficacy of herbs in the treatment of pain is insufficient; the underlying mechanisms are unclear and, safety and toxicity remain a concern.
Keywords: cancer pain; tradition Chinese medicine; treatment; review
Cancer pain is one of the commonly seen symptoms of malignant tumors. 70~90% patients in middle or late stage of cancers suffers from pain to different degrees, among which, patients with late period of breast cancer, prostate cancer and lung cancer making up around 80%, and it seriously affected the patients’ quality of life. Current west medicine therapies mainly include three step analgesic ladder management, biological therapy and nerve block therapy based on antitumor treatment. However, after conventional treatment, there’re still around 36%~50% patients with cancer who are suffering the pain which is severe enough to affect their daily life. On the other hand, cancer pain prolongs the hospitalization of patients which will increase medical expenditures and the burden of the state and society.
TCM holds that obstruction of meridians and collaterals is the basic pathogenesis of cancer pain, while the main pathogenesis of cancer pain are “pain due to being obstructed” and “pain due to lack of nourishing”. Generally, the pathological characters of cancer pain are deficiency in the fundamental and excess in the incidental, usually the disease is caused by deficiency while the pain is resulted from excess. It’s a problem with general deficiency and local excess. TCM treatment on cancer pain is effective, economical and of less side effects, it enriches the contents of cancer pain treatment.

Research showed that pathological mechanism of bone cancer main was mainly related to tumor factors, changes of local bone tissues and changes of central nervous system. Tumor tissues oppressed and invades nearby sensory nerves, tumor cells and related immune cells released inflammatory factors sensitized peripheral nociceptor, bone destruction resulted from tumors and local microenviroment of ischemia and anoxia was the initial factor of bone cancer pain. Under persisting stimulation of these factors, the central nervous system was also sensitized and exerted important effect on the maintaining of bone cancer pain.

With the further clinical research on treating cancer pain by TCM, the mechanism research on treating cancer pain with TCM is also gradually carried out. Deng Bo, et al established bone cancer pain models by inoculating rat metastatic breast cancer cell strain MRMT-1 cell to both hind tibias of rats, and divided them into model group, oledronicacid group, TCM group and sham surgery group. The hind limbs were soaked into 3% infusion of stagnant Blood dissolving and pain relieving formula 2-21 days after model establishment, 60 minutes each time, twice daily. The influence of stagnant Blood dissolving and pain relieving formula was observed by checking pain behaviours, bone density, etc., the results showed that TCM stagnant Blood dissolving and pain relieving formula could effectively treat bone cancer pain, reduce the osteolytic bone destruction caused by bone metastasis, and elevate bone mineral substance contents and bone density level.

The effect of TCM treatment on cancer pain should be specific, also persistent, non-addictive and non-drug tolerant. The method can be located as the first and second step of WHO three step analgesic ladder management, and can also be the priority for the medicine combination in the third ladder, so that the dosage of opiods can be decreased and the toxic/side effects induced by opiod can be reduced. TCM analgesic method lays emphasis on syndrome differentiation and disease differentiation and combination of internal administration and external application. Only through these way, satisfactory analgesic effect can be obtained.
Unified, internationally recognized and widely accepted therapeutic effect criteria should be adopted, and placebo or simulation should be used reasonably, so that the clinical therapeutic effect of TCM on cancer pain can be evaluated correctly and objectively, and better high-effective TCM compound can be found. Many studies are on self-formulated prescriptions which are mainly on their own clinical experience. These prescription are not unified, and usually are traditional Chinese preparations without quantitative indices, quality control and clear effective ingredients. With the improvement of manufacturing techniques, and the strict requirements on drug clinical test regulations, corresponding methods should be taken for medicine quality control to guarantee the quality of the medicine.
Currently the preparations in use are of traditional ones, they’re of simple preparations without accurate quantitative indices and support of modern pharmaceutical methods and techniques. There’s few reports on safety or toxic effects on the cancer pain killer medicine either for oral administration or external application, related determination for indices involved and corresponding evaluating standards are absent. Modern pharmaceutical methods and techniques should be used, and studies and applications of new technologies such as TCM transdermal system and nanoparticle drug delivery system should be strengthened for the purpose of developing advance preparations and find a new way of TCM modernization, so that it can be promoted and applied in cancer three-step analgesic ladder method, accepted by international scholars and consistent with international standards.
Many studies are only of observation on analgesic effect, there’s no systematic and further experimental research or discussion on mechanism, and there’s no breakthrough on TCM treating cancer pain. Developed animal models provides good platform for the mechanism research of cancer pain. On that basis, cancer pain models according with TCM theory should be studied and established, modern oncology, immnunology, pharmacology, image science and other modern molecule biological theory and technology should be combined to carry out experimental research on cancer pain and further research on the mechanism, so that scientific foundations can be provided for the development of TCM resources and effective and safe TCM medicine for cancer pain.

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