VANCOUVER, BC-The US Agency for Health Care Policy and Research (AHCPR) cancer pain practice guidelines, like the World Health Organization (WHO) 3-step ladder, emphasize a hierarchical pain management strategy, Richard Payne, MD, said at a symposium held in conjunction with the 8th World Congress on Pain of the International Association for the Study of Pain (IASP).
Dr. Payne, chief of the Section of Pain and Symptom Management, The University of Texas M.D. Anderson Cancer Center, described the AHCPR guidelines as a pyramid, with the base representing use of oral, transdermal, and rectal drugs; circling the pyramid, in his imagery, are ribbons representing important adjuvant therapies.
Determine the Cause of Pain
"Although systemic analgesics are the base and cornerstone of therapy, and are effective in at least 75% to 85% of cancer patients reporting moderate to severe pain, they should always be used in the context of an appropriate assessment that tries to determine the cause of the pain," he said.
The cause should be treated, if possible, with antineoplastic therapies, palliative radiotherapy, adjuvant drugs, and physical and psychosocial modalities.
The top of the pyramid includes more invasive approaches to pain treatment such as the use of intravenous and subcutaneous opioids and epidural or intrathecal subarachnoid analgesia, Dr. Payne said.
At the very top, for use in perhaps 1% to 5% of the total universe of patients with severe cancer pain, are nerve blocks, palliative surgery, and ablative neurosurgical approaches.