Palliative Care and Pain Medicine Come Together to Optimally Treat Cancer Pain: What We Can Learn from the British Pain Society

Abstract

“We don't beat the Reaper by living longer. We beat the Reaper by living well.” Professor Randy Pausch declared this statement during his famous last lecture at Carnagie Mellon University prior to his death from pancreatic cancer in 2008 [1]. As opposed to the widely practiced WHO approach of utilizing opioids in a stepladder fashion, many now advocate a mechanism-based approach to cancer pain treatment. Old dogma treated cancer pain as a problem mainly toward the end of life situation in the context of metastatic, progressive disease, whereas new data show pain to be problematic throughout the cancer care cycle [2]. The effective management of these acutely painful surgeries and related treatments may limit the development of chronic pain states in long-term survivors [3]. Effective treatment strategies include multidisciplinary, multimodal care utilizing 1) combinations of long-acting opioids for constant pain with short-acting opioids for incidental pain; 2) “adjuvant” co-analgesics including nonsteroidal anti-inflammatories, anticonvulsants, antidepressants, and topical agents to optimize analgesia and minimize opioid doses, thereby reducing concomitant opioid-related side effects; 3) prophylactic treatment of constipation, nausea, and other common troublesome symptoms; 4) interventional …