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Pain management of the cancer patient |
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| Authors: | Stephan A Schug Chandani Chandrasena |
| Institution: | 1. Professor, Chair of Anaesthesiology, The University of Western Australia, School of Medicine and Pharmacology, Pharmacology, Pharmacy and Anaesthesiology Unit, Perth, Australia;2. Consultant Anaesthetist and Director of Pain Medicine, UWA Anaesthesiology, Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Level 2, MRF Building, GPO Box X2213, Perth, 6847, Australia +61 8 9224 0201;3. +61 8 9224 0279;4. stephan.schug@uwa.edu.au;5. Senior Registrar and Clinical Lecturer, Royal Perth Hospital, Department of Anaesthesia and Pain Medicine, Perth, Australia |
| Abstract: | Introduction: Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. Areas covered: The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended. Expert opinion: There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines. |
| Keywords: | cancer pain co-analgesics non-opioids opioids WHO guidelines |