Research Article| Volume 33, SUPPLEMENT 4, S55-S62, May 1997

Pain control in patients with cancer

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      Pain is common in cancer patients, although its prevalence varies with the primary site and stage of the malignancy. High rates of pain are observed with prostate, bone, and gynaecological primary cancers, while it is usually less problematic in haematological malignancies. Unfortunately, many patients and healthcare professionals still believe that the late stages of cancer are inevitably painful, which leads to therapeutic nihilism. Clinicians should recognize that ‘cancer pain’ may arise not only from the malignancy, but also from its treatment and the presence of concomitant conditions. Current research focuses on the mechanisms, treatment, and consequences of pain. Recent advances have been made with novel agents, such as N-methyl-d-aspartate (NMDA) receptor antagonists, and new formulations, such as transdermal drug delivery systems. Non-analgesic approaches to pain control, such as the use of bisphosphonates or intravenous radionuclides for bone metastases, and the roles of nerve blocks and orthopaedic surgery, soon will be evaluated. Quality-of-life and satisfaction studies are needed to evaluate the impact of pain on patient functioning and its effects on family, social, and economic life. The World Health Organization has proposed a three-tier approach to cancer pain management, in which drugs ranging from non-steroidal anti-inflammatory drugs (NSAIDs) to strong opiates are titrated to the level of pain. Oncologists have an important role in implementing this approach and in seeking more rational legislation concerning the prescribing of opioids for the treatment of cancer pain.

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