Cancer pain management current strategy
- 1 December 1993
- Vol. 72 (S11), 3393-3415
- https://doi.org/10.1002/1097-0142(19931201)72:11+<3393::aid-cncr2820721606>3.0.co;2-o
Abstract
Pain is among the most prevalent symptoms experienced by cancer patients. A strategy for the management of cancer pain is now widely accepted, and when well implemented, is usually effective. Unfortunately, many oncologists are ill-prepared for the task of pain assessment and management, and the outcomes achieved in clinical practice are often suboptimal. The various elements in the pain management strategy are described. Patient assessment, the use of primary therapies and systemically administered nonopioid and opioid analgesics are pivotal to the strategy. Practical aspects of opioid pharmacotherapy encompass drug selection and dosing considerations including selection of an appropriate route of administration, dose titration, and the management of side effects. Specific approaches are described for the treatment of patients for whom an acceptable balance between relief and side effects of opioids is not achieved. These comprise noninvasive interventions, including the use of adjuvant analgesics, psychological therapies, and physiatric techniques, and invasive interventions, such as the use of intraspinal opioids, neural blockade, and neuroablative techniques. Finally, the use of sedation in the treatment of patients with pain that is refractory to other interventions is addressed. The skilled application of this strategy can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should see specialists in pain management or palliative medicine who can address these difficult problems.Keywords
This publication has 112 references indexed in Scilit:
- Epidural opiates and local anesthetics for the management of cancer painPain, 1991
- Infection as a cause of rapidly increasing pain in cancer patientsJournal of Pain and Symptom Management, 1991
- Chronic nausea and morphine-6-glucuronideJournal of Pain and Symptom Management, 1991
- Cancer pain management according to WHO analgesic guidelinesJournal of Pain and Symptom Management, 1990
- Epidural versus intrathecal morphine-bupivacaine: Assessment of consecutive treatments in advanced cancer painJournal of Pain and Symptom Management, 1990
- Preliminary Report: Effect of Encainide and Flecainide on Mortality in a Randomized Trial of Arrhythmia Suppression after Myocardial InfarctionNew England Journal of Medicine, 1989
- The Physician's Responsibility toward Hopelessly Ill PatientsNew England Journal of Medicine, 1989
- A dosing nomogram for continuous infusion intravenous naloxoneAnnals of Emergency Medicine, 1986
- The Treatment of Cancer PainNew England Journal of Medicine, 1985
- Addiction Rare in Patients Treated with NarcoticsNew England Journal of Medicine, 1980