CANCER PAIN MANAGEMENT - CURRENT STATEGY

Pain is among the most prevalent symptoms experienced by cancer patien ts. A strategy for the management of cancer pain is now widely accepte d, and when well implemented, is usually effective. Unfortunately, man y oncologists are ill-prepared for the task of pain assessment and man agement, and the outcomes achieved in clinical practice are often subo ptimal. The various elements in the pain management strategy are descr ibed. Patient assessment, the use of primary therapies and systemicall y administered nonopioid and opioid analgesics are pivotal to the stra tegy. Practical aspects of opioid pharmacotherapy encompass drug selec tion and dosing considerations including selection of an appropriate r oute of administration, dose titration, and the management of side eff ects. Specific approaches are described for the treatment of patients for whom an acceptable balance between relief and side effects of opio ids is not achieved. These comprise noninvasive interventions, includi ng the use of adjuvant analgesics, psychological therapies, and physia tric techniques, and invasive interventions, such as the use of intras pinal opioids, neural blockade, and neuroablative techniques. Finally, the use of sedation in the treatment of patients with pain that is re fractory to other interventions is addressed. The skilled application of this strategy can provide adequate relief to the vast majority of p atients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should see specialists in pain managemen t or palliative medicine who can address these difficult problems.