TY - JOUR
T1 - Pain in the cancer patient
T2 - Different pain characteristics CHANGE pharmacological treatment requirements
AU - Müller-Schwefe, Gerhard
AU - Ahlbeck, Karsten
AU - Aldington, Dominic
AU - Alon, Eli
AU - Coaccioli, Stefano
AU - Coluzzi, Flaminia
AU - Huygen, Frank
AU - Jaksch, Wolfgang
AU - Kalso, Eija
AU - Kocot-Keopska, Magdalena
AU - Kress, Hans Georg
AU - Mangas, Ana Cristina
AU - Ferri, Cesar Margarit
AU - Morlion, Bart
AU - Nicolaou, Andrew
AU - Hernández, Concepción Pérez
AU - Pergolizzi, Joseph
AU - Schäfer, Michael
AU - Sichère, Patrick
PY - 2014
Y1 - 2014
N2 - Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms-rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level.
AB - Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms-rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level.
KW - Breakthrough pain
KW - Causative mechanisms
KW - Chemotherapy-induced neuropathic pain
KW - Fast-acting fentanyl formulations
KW - Multidisciplinary approach
KW - Opioids
KW - Under-treatment
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U2 - 10.1185/03007995.2014.925439
DO - 10.1185/03007995.2014.925439
M3 - Article
C2 - 24841174
AN - SCOPUS:84906837545
SN - 0300-7995
VL - 30
SP - 1895
EP - 1908
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 9
ER -