PAIN MANAGEMENT IN ONCOLOGY

Basic guidelines for cancer pain treatment can be found in many differ ent handbooks published in the last years. Particularly those of the W orld Health Organisation published in 1986 and revised in 1996, furnis h useful indication for cancer pain treatment. The authors therefore f ocused on resuming the most recent development in this field. In the r esearch regarding alternative routes of administration of opioids in a lternative to the oral route, the rectal administration of morphine an d methadone and the transdermal route for fentanyl have proved to be e fficacious. The subcutaneous route (for morphine) as well as the intra venous, peridural and subaracnoid routes, being known for some time ar e not taken in consideration in this paper. Various studies suggest th at alternative routes are necessary in 53-70% of patients in their las t days or months of live. The most frequent causes for the need to sto p oral administation are dysphagia, nausea, and uncontrollable vomitin g, bowel obstruction, malabsorption, cognitive failure, coma, and pain syndromes requiring anaesthetics wich need be administered via the sp inal route. Among the drugs, tramadol seems to be effective in the con trol of moderate pain. Tramadol is a centrally acting analgesic drug; it has an agonist effect on mu 1 receptors of opioids and acts also by inhibiting the re-uptake of noradrenaline and serotonine which activa tes descending monoaminergic inhibitory pathways. Recent clinical stud ies revealed that pamidronate has an analgesic effect in pain due to b one metastasis. Pamidronate is part of the biphosphonates, which are a ctive on bone metabolism and are usually being used for the treatment of hypercalcaemia in cancer. The authors also describe briefly the Ind ication of ketamin in association with morphine for the treatment of n europathic pain.