Management Of Cancer-related Pain Research Articles

Pain syndromes in HIV infection.

Pain causes considerable disability and discomfort in HIV (Human Immunodeficiency Virus) infected individuals. A large number of patients infected with HIV suffer from one or more pain-related syndromes. Pain is under-reported and suboptimally managed in these patients. An outline of the different pain syndromes, including headache, oral cavity pain, chest pain, abdominal pain, anorectal pain, musculoskeletal pain and peripheral neuropathic pain, and their aetiologies are discussed. Current pain management modalities, including non-narcotic and narcotic analgesics, tricyclic antidepressants, anticonvulsants, physical therapy and psychological techniques, are outlined. Treatment should be based on the same principles applied to the management of cancer-related pain. A multi-disciplinary, comprehensive approach to pain management will assist these individuals to achieve improved levels of comfort, function and quality of life in this ultimately terminal illness.

Management of cancer pain with transdermal fentanyl: Phase IV trial, University of Iowa

A multicenter study was conducted to determine the patient and physician acceptability of transdermal fentanyl in the management of cancer-related pain. In this study, 10 cancer patients at the University of Iowa received transdermal fentanyl after discontinuing their prior opioid analgesic; 7 patients completed questionnaires before and at 2 and 4 wk following transdermal fentanyl application. There was no significant difference in visual analogue scale scores for pain or mood. Verbal pain descriptor scores improved at 2 wk ( P < .05). There was a nonsignificant tendency toward increased depression and nausea; however, patients spent less time thinking about their illness and felt their cancer was less disruptive to their closest friends/relatives. Constipation, appetite, drowsiness, and concentration were not statistically different. Patients reported improved sleep habits at 2 wk ( P < .05) and tended to require less help with eating, dressing, washing, and using the bathroom. All patients completing the study chose to continue transdermal fentanyl for their cancer pain management. In summary, these data demonstrate the analgesic efficacy of the transdermal fentanyl system and suggest that some patients with cancer-related pain could benefit from its use.

Diclofenac and naproxen are equal in cancer-related pain management

Diclofenac and naproxen are equal in cancer-related pain management

The Masagement of Cancer Related Pain

Some foreign reports state that 60∼87? of patients hospitalized with cancer suffer with pain. The cancer patients usua17y have exacerbation of pain corresponding to the progre-ssion of the disease. The management of cancer relate? pain includes the followings : 1) Attacking the pathologr causin? the pain 2) Raising the pain thresheld 3) Modulating the pain pathway 4) Interrupting the pain pathwazy. The most important aspect in management of cancer related pain is stepladder approach to ana17esic tailoring. The development of toleranoe with prolonged uke of analgesics requires increasing dose of analgesics. Not only does the increased dose of analgesics affect analgesia but also increases side effectg increases. Chemical nerve blocks and neurosurgical ablation can be used in management of terminal cancer patients. With the development of multimodal approaches to caring cancer patients one shruld be cautious in Using ablative therapy. ln our pain clinics, 123 cancer related pain patients have been managed with non-narc-odic analgesics, narcotic analgesics, celiac plexus block, and intrathecal phenol block, imp-lant ation of permanent epidural catheter.

Psychological approaches to the management of cancer-related pain

C ANCER-RELATED PAIN (pain secondary to the disease and/or its treatment) afflicts 50% to 80% of patients with metastatic disease. 1-3 The management of cancer-related pain has been based primarily on somatic treatments, including (I) pharmacologic approaches, eg, nonnarcotics, narcotics, and antidepressants; (2) neurosurgical, neuroablative, and neurostimulatory approaches; (3) anesthetic approaches, eg, epidural infusion of local anesthetics, nitrous oxide; and (4) radiation approaches. 45 Although great advances in the somatic treatments of cancer-related pain have been made, numerous difficulties remain: (1) no treatment is consistently effective; (2) the effects of pharmacologic treatments diminish over time as tolerance develops, necessitating dosage escalation; (3) pharmacologic treatments often produce negative side effects including nausea and vomiting, constipation, respiratory depression, and sedation; 6 (4) surgical procedures often provide only temporary relief, with pain recurring within several weeks; 6 and (5) complications of surgical procedures include weakness or paralysis, orthostatic hypotension, and sexual dysfunction. 7 These problems with somatic treatments have stimulated the search for alternate treatment approaches. Noyes 8 proposed that an understudied area is psychologic approaches to the treatment of cancer-related pain.