Pharmacologic management of pain in patients with cancer - Tips from Other Journals

Author: Kathryn M. Andolsek
Date: Feb 15, 1997

Holistic management of patients with cancer requires a solid foundation in the principles of pain management. Pain coexists with other common cancer symptoms such as fatigue, weakness, dyspnea, nausea, constipation and impaired cognition, and treating one of these conditions without worsening another can be challenging. Virtually all patients can be effectively treated with individualized integrated programs that combine systemic, pharmacologic, anticancer and, occasionally, invasive therapies. Levy discusses basic approaches to pain control and provides practical clinical guidelines for its treatment.

The author describes three basic approaches to the control of pain: modifying its source(s), altering the central perception of pain and blocking its transmission to the central nervous system. The Three-Step Analgesic Ladder of the World Health Organization is presented as a model of care. Selection of the appropriate analgesic drug is discussed, along with recommendations for the appropriate dosage, route of administration and dosing interval. Useful strategies to prevent persistent pain and relieve breakthrough pain are also discussed. The author outlines how to titrate the dosage of the drug aggressively, yet at the same time anticipate and manage its side effects. The use of sequential trials of analgesic medications and appropriate adjuvant drugs for common pain syndromes is also outlined.

The author concludes that pain relief in patients with cancer remains inadequate because of a lack of education about pain and the appropriateness of opioid therapy. The author believes that most clinicians should be able to optimize their patients' comfort and their ability to function by following the guidelines of pain management presented here.

Levy MH. Pharmacologic treatment of cancer pain. N Engl J Med 1996;335:1124-32.

"Tips from Other Journals" are written by the associate editors of American Family Physician.

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