Cancer Patient: Controlling The Pain
Clinical guidance for the treatment of cancer pain has been established by the National Comprehensive Cancer Network1 and the American Pain Society.2 Both organizations emphasize that clinicians should provide a comprehensive pain assessment to identify the etiology of each patient's pain. The World Health Organization (WHO) analgesic ladder3 developed in 1986, provided an important schematic at a time when it was well recognized that cancer pain was grossly undertreated.4,5 Even today many oncologists turn to the WHO analgesic guidelines for some schematic approach to treating pain (Figure 1).
For mild to moderate pain, patients will generally be managed with non-opioids (or non-scheduled opioids, depending on the state) such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), tramadol, or other adjunctive medications. Together with physical therapy, heat/cold therapy, and various modalities, these are the first step in the ladder. For moderate to severe pain, patients may be managed with schedule III opioids (generally considered to be "mild" or "weaker" opioids) such as buprenorphine, codeine, or hydrocodone, usually combined with acetaminophen or an NSAID. Morphine, hydromorphone, oxycodone, oxymorphone, methadone, and fentanyl are generally considered to be "strong" opioids (Table 1). More correctly stated, none of these opioids are "strong" or "weak," because their activity is a function of opioid-binding affinity, potency, opioid receptor physiology, and polymorphic differences. In short, a "weak" opioid in one patient may very well be a "strong" opioid in another, and visa versa.6
Read more on the Pharmaceutical Treatment of the Cancer Pain Patient.