Article

The Pharmacologic Management of Cancer Pain

Department of Medicine, University of Wisconsin, Madison, Wisconsin 53792, USA.
Journal of Palliative Medicine (Impact Factor: 1.91). 01/2008; 10(6):1369-94. DOI: 10.1089/jpm.2007.9842
Source: PubMed

ABSTRACT

The under treatment of cancer pain is still a major issue in both oncology and palliative medicine. The initial availability of opioids is seen as an important philosophical step forward in the pharmacological treatment of cancer pain, one for which there continues to be considerable barriers within regulatory and medical domains. Knowledge of the key pharmacological properties of the multiple opioids available will assist in both improved analgesia and side effects. Understanding the mechanisms of pain is important in terms of treatment, especially in terms of the choice of co-analgesic agents. Much of the work obtained from the study of cancer patients is applicable to the non cancer populations, as is work performed in non cancer patients with neuropathic pain.

Download full-text

Full-text

Available from: James F Cleary, Sep 03, 2014
    • "Although conventional medicine has well-established guidelines to systemically control cancer-related pain [11], over half of all cancer patients still suffer significant pain, which affects their quality of life [12] . Pharmacologic treatment is not always sufficient [13, 14], and serious adverse effects may limit the use of the analgesics [15, 16]. The United States and Europe have developed guidelines on complementary and alternative medicine (CAM), but they are not comprehensive. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Controlling cancer-related pain is an important component in the palliative care of cancer patients. The objective of this review was to assess the effectiveness of acupuncture for treating cancer pain. Fourteen databases were searched from their inception through April 2011. Randomised clinical trials (RCTs) were included if acupuncture was used as the sole treatment or as a part of a combination therapy for cancer pain. Studies were included if they were controlled with a placebo or controlled against a drug-therapy or no-treatment group. The Cochrane criteria were used to assess the risk of bias. A total of 15 RCTs met our inclusion criteria. All of the included RCTs were associated with a high risk of bias. The majority of acupuncture treatments or combination therapies with analgesics exhibited favourable effects compared with conventional treatments in individual studies. However, a meta-analysis suggested that acupuncture did not generate a better effect than drug therapy (n = 886; risk ratio (RR), 1.12; 95% CI 0.98 to 1.28; P = 0.09). The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy (n = 437; RR, 1.36; 95% CI 1.13 to 1.64; P = 0.003). The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain. The total number of RCTs included in the analysis and their methodological quality were too low to draw firm conclusions. Future rigorous RCTs will be necessary to assess the clinical efficacy of acupuncture in this area.
    No preview · Article · Mar 2012 · Supportive Care in Cancer
  • Source
    • "Patients with pain or severe paresthesias may require symptom-directed pharmacotherapy. Options that have proven effective in this respect include the anticonvulsants gabapentin and pregabalin; serotonin-norepinephrine reuptake inhibitors such as duloxetine; tricyclic antidepressants amitriyptyline and desipramine; and opioids such as oxycodone, morphine sulfate, and hydrocodone.63 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple myeloma (MM) is a B-cell malignancy characterized by clonal expansion of plasma cells within the bone marrow, the presence of a serum and/or urine monoclonal protein, lytic bone lesions, and anemia. On a cellular level, the disease is characterized by complex interactions between tumor cells and the surrounding bone marrow microenvironment. Understanding of the relationship between malignant plasma cells and the microenvironment has sparked ongoing efforts to develop targeted therapeutic agents for treatment of this disease. The successful development of the first-in-class small-molecule proteasome inhibitor bortezomib occurred as a result of these efforts. This review focuses on the rationale for bortezomib therapy in the treatment of patients with newly diagnosed and relapsed MM, important treatment-related side effects, and future directions for use of bortezomib and other, emerging proteasome inhibitors.
    Full-text · Article · Sep 2009 · Cancer Management and Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Opioids are frequently prescribed for moderate to severe pain. A side effect of opioid usage is the inhibition of gastrointestinal (GI) motility, known as opioid-induced bowel dysfunction (OBD). OBD is typically treated prophylactically with laxatives and/or acid suppressants. The present study describes the prevalence of outpatient opioid dispensing, opioid patient demographics, and concomitant dispensing of opioids and GI medications in the Quebec Public Prescription Drug Insurance Plan in 2005. Using a retrospective cohort design, opioid dispensings were identified using claims and reimbursement data. Laxative and acid suppressant dispensings were also identified. Concurrent use was defined as having at least one 'GI medication-exposed day' overlapping an 'opioid-exposed day'. More than 11% of the drug plan population was dispensed an opioid in 2005, and dispensings increased with age. Approximately two-thirds of patients who received an opioid were given codeine. Approximately one-third of opioid patients were concomitantly dispensed a GI medication, yet only 2% were dispensed a laxative. Although the GI side effects of opioids are well known, these side effects appear to increase with age and duration of opioid use. Opioid-related side effects, particularly OBD, should be effectively managed so as not to lead to the cessation of opioid therapy.
    Preview · Article · Sep 2008 · Pain research & management: the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur
Show more