Assessment and treatment of neuropathic cancer pain following WHO guidelines

Neuropathic pain syndromes are one of the major problems of cancer pain tre atment. The present study surveys 593 cancer patients treated by a pain ser vice following the WHO guidelines for relief of cancer pain. Of these, 380 presented with nociceptive, 32 with neuropathic and 181 with mixed (nocicep tive and neuropathic) pain. In patients with nociceptive, mixed and neuropa thic pain, the average duration of evaluated pain treatment was 51, 53 and 38 days, respectively. Non-opioid or opioid analgesics were given to 99%, 9 6% and 79%, antidepressants to 8%, 25% and 19%, anticonvulsants to 2%, 22% and 38% and corticosteroids to 26%, 35% and 22% of patients, respectively. Systemic analgesia was supported by palliative antineoplastic treatment (48 %, 56% and 38% of patients), nerve blocks (3%, 6% and 6%), psychotherapy (3 %, 7% and 3%), physiotherapy (6%, 12% and 13%) and transcutaneous electric nerve stimulation (1%, 6% and 6%). Analgesic treatment resulted in a signif icant pain relief in all groups of patients, as the mean pain intensity (NR S) decreased from 66 (nociceptive), 65 (mixed) and 70 (neuropathic) on admi ssion to 26, 30 and 28 after 3 days and 18, 17 and 21 at the end of survey. The total outcome of pain treatment was not predicted by the designation t o nociceptive, mixed or neuropathic pain. In conclusion, neuropathic cancer pain is not intractable and can be relieved in the majority of patients by treatment following the WHO guidelines. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.