Abstract
Opioids comprise an important group of drugs used in cancer pain pharmacotherapy. In recent years, more and more studies have emerged indicating the potentially immunosuppressive effects of opioid analgesics and their serious consequences, including the risk of cancer progression. The identification of these risks has prompted a search for other effective, and most importantly, safer methods of perioperative analgesic management. Regional analgesia techniques, which allow for a significant reduction in opioid dosing and thus diminish the risk of immunosuppression associated with these drugs, seem to offer substantial hope in this respect. A number of studies available in the literature assess the effects of regional analgesia techniques on cancer progression; however, it is often difficult to interpret their results owing to several perioperative factors (such as surgical trauma, inadequate pain and stress relief, and hypothermia) which are also attributed immunosuppressive effects and tend to be implicated in increased risk of cancer progression. Further research is needed to verify the available data on both the potential adverse effects of opioids and the possible protective effects of regional analgesia techniques on cancer patients.
Highlights
Cancer pain poses a serious clinical and epidemiological problem
Experimental and clinical studies show the importance of effective pain management for checking cancer progression
Apart from the basic humanitarian aspect, these data provide an argument for the need to effectively alleviate stress and suffering in cancer patients. e question of how to do it optimally and in the safest possible way is still relevant, given the substantial evidence concerning the potentially adverse opioid effects to have emerged in recent studies
Summary
Cancer pain poses a serious clinical and epidemiological problem It may be the first symptom of the disease, occurs during its diagnosis and treatment, and accompanies patients at the advanced stages of the disease. Is is important in cancer patients as more and more data indicate a correlation between severe pain and increased risk of cancer progression and a shorter time to the appearance of metastatic lesions [3]. Andersen et al. Pain Research and Management demonstrated that the stress associated with the diagnosis and surgical treatment of breast cancer in women impaired their immune cell response, including NK cell toxicity and T-cell responses. Experimental and clinical studies demonstrate the importance of effective pain management in terms of cancer progression. Morphine has immunosuppressant properties which can promote cancer, but on the other hand suppressing of pain alleviates the surgical stress and might be protective against tumour metastases
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