Large surveys of populations with cancer pain indicate that as many as 90% of patients can attain adequate relief of pain using optimal, systemic, opioid-based pharmacotherapy. Skilled clinicians should be able to achieve
Russell K. Portenoy, MD
Economic analysis of cancer pain management is hampered by the lack of systematic outcomes research. There is some consensus on the broad structures that should be in place to provide optimal care, but the relative costs and
Dr. Peter Staats presented the case of a 15-year-old, 40-kg boy with a primitive neurectodermal tumor located in
Drug abuse presents a complex set of physical and psychosocial issues that complicate cancer treatment and pain/symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction.
Neuropathic pain may be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. This pathophysiologic label is typically applied when the painful symptom is associated
Fatigue is one of the most common symptoms experienced by patients with cancer and other progressive diseases. Although reported to be a major obstacle to maintaining normal daily activities and quality of life, remarkably few studies of this syndrome have been conducted.
The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the
Opioid rotation is now considered
standard practice in the
management of cancer pain.
The rationale for the approach has
been well summarized by Estfan and
colleagues. Rotation should be viewed
as one strategy among many to deal
with patients who demonstrate relatively
poor responsiveness to an opioid.[
1] Application of well accepted
clinical guidelines for opioid administration,
beginning with those originally
promulgated by the World
Health Organization, emphasize
the need to individualize the opioid
dose through a process of gradual
dose titration, irrespective of the specific
drug. Most cancer patients attain
an adequate balance between
analgesia and side effects, at least
initially. Some, however, experience
treatment-limiting toxicity, the sine
qua non of “poor responsiveness.”
This response reflects an outcome that
is related to a specific drug, route of
administration, set of patient-related
variables, and time.
As indicated in this review by Patt and Ellison, the literature pertaining to the association between transitory acute pains and chronic cancer-related pain is limited and plagued by nomenclatural problems. Nonetheless, the clinical relevance of these so-called breakthrough pains is apparent to those who treat cancer patients.
In their article, Drs. Choi and Billings address a number of strategic areas in palliative care. These topics include the definition and scope of the evolving field, the complexities involved in the use of modalities that carry burden or risk (such as artificial nutrition and bowel decompression), and the underappreciated importance of communication skills and a capacity for ethical reasoning.