Cancer pain: Beyond the ladder

Current estimates indicate that between 50 and 90% of patients with cancer experience pain. The World Health Organization has outlined a three-step analgesic ladder, that, if followed will result in close to 90% pain relief. Opioids should not be withheld for fear of addiction or respiratory depression and are clearly the most effective systemic analgesic available for patients with cancer-related pain. Unfortunately, opioids can also cause side effects including, but not limited to, constipation and mental cloudiness. Interventional therapies and physical modalities can decrease pain without systemic side effects associated with opioids and should be considered a useful adjunct in the battle against pain. It is likely that by incorporating interventional and non-pharmacologic approaches, the success rate of pain control and the quality of life can be improved.