Open AccessThe management of cancer pain
Author(s) -
Cherny Nathan I.,
Portenoy Russell K.
Publication year - 1994
Publication title -
ca: a cancer journal for clinicians
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 62.937
H-Index - 168
eISSN - 1542-4863
pISSN - 0007-9235
DOI - 10.3322/canjclin.44.5.263
Subject(s) - medicine , psychological intervention , cancer pain , sedation , intensive care medicine , refractory (planetary science) , opioid , palliative care , pharmacotherapy , pain management , physical therapy , cancer , anesthesia , psychiatry , physics , receptor , nursing , astrobiology
Surveys indicate that clinicians are frequently ill equipped to treatcancer pain. Pain is often poorly assessed, and many caregivers lacksufficient knowledge to optimize treatment. Effective management requiresan understanding of pain pathophysiology, the ability to identify andevaluate pain syndromes, and familiarity with proven therapeuticstrategies. Opioid pharmacotherapy is the mainstay of treatment. Practicalaspects of opioid therapy include selection of both drug and route, dosetitration, and management of side effects. Specific strategies for themanagement of patients who are unable to attain an acceptable balancebetween pain relief and side effects include both noninvasive interventions (such as adjuvant analgesics, psychological therapies, and physiatrictechniques) and invasive interventions (such as the use of intraspinalopioids, neural blockade, and neuroablative therapies). Sedation is anoption at the end of life for the treatment of pain that is refractory toother interventions. These approaches can provide adequate relief to thevast majority of patients, most of whom will respond to systemicpharmacotherapy alone. Patients with refractory pain should have access tospecialists in pain management or palliative medicine.