World Health Organization Cancer Pain Research Articles

Genetic implications in quality palliative care and preventing opioid crisis in cancer-related pain management.

The prevalence of cancer-related pain is 64% among patients with metastatic, advanced, or terminal cancer, 59% among patients undergoing anticancer treatment, and 33% among patients who completed curative treatment. According to the World Health Organization cancer pain relief guidelines, opioid analgesics are the mainstay analgesic therapy in addition to conventional first-step analgesics, such as non-steroidal anti-inflammatory drugs and acetaminophen. The indications for strong opioids have recently been expanded to include mild-to-moderate pain in addition to moderate-to-severe pain. The U.S. Centers for Disease Control and Prevention guidelines emphasize that realistic expectations should be weighed against potential serious harm from opioids, rather than relying on the unrealized long-term benefits of these drugs. Therefore, treatment strategies for both cancer-related chronic or acute pain have been unfortunately deviated from opioid analgesics. The barriers hindering adequate cancer-related pain management with opioid analgesics are related to the inadequate knowledge of opioid analgesics (e.g., effective dose, adverse effects, and likelihood of addiction or tolerance). To achieve adequate opioid availability, these barriers should be overcome in a clinically suitable manner. Genetic assessments could play an important role in overcoming challenges in opioid management. To balance the improvement in opioid availability and the prevention of opioid misuse and addiction, the following two considerations concerning opioids and genetic polymorphisms warrant attention: (A) pain severity, opioid sensitivity, and opioid tolerance; and (B) vulnerability to opioid dependence and addiction.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults.

Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Non-opioid drugs are commonly used to treat cancer pain, and are recommended for this purpose in the World Health Organization (WHO) cancer pain treatment ladder, either alone or in combination with opioids.A previous Cochrane review that examined the evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain was withdrawn in 2015 because it was out of date; the date of the last search was 2005. This review, and another on paracetamol, updates the evidence. To assess the efficacy of oral NSAIDs for cancer pain in adults, and the adverse events reported during their use in clinical trials. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to April 2017, together with reference lists of retrieved papers and reviews, and two online study registries. We included randomised, double-blind, single-blind, or open-label studies of five days' duration or longer, comparing any oral NSAID alone with placebo or another NSAID, or a combination of NSAID plus opioid with the same dose of the opioid alone, for cancer pain of any pain intensity. The minimum study size was 25 participants per treatment arm at the initial randomisation. Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality and potential bias. We did not carry out any pooled analyses. We assessed the quality of the evidence using GRADE and created a 'Summary of findings' table. Eleven studies satisfied inclusion criteria, lasting one week or longer; 949 participants with mostly moderate or severe pain were randomised initially, but fewer completed treatment or had results of treatment. Eight studies were double-blind, two single-blind, and one open-label. None had a placebo only control; eight compared different NSAIDs, three an NSAID with opioid or opioid combination, and one both. None compared an NSAID plus opioid with the same dose of opioid alone. Most studies were at high risk of bias for blinding, incomplete outcome data, or small size; none was unequivocally at low risk of bias.It was not possible to compare NSAIDs as a group with another treatment, or one NSAID with another NSAID. Results for all NSAIDs are reported as a randomised cohort. We judged results for all outcomes as very low-quality evidence.None of the studies reported our primary outcomes of participants with pain reduction of at least 50%, and at least 30%, from baseline; participants with Patient Global Impression of Change (PGIC) of much improved or very much improved (or equivalent wording). With NSAID, initially moderate or severe pain was reduced to no worse than mild pain after one or two weeks in four studies (415 participants in total), with a range of estimates between 26% and 51% in individual studies.Adverse event and withdrawal reporting was inconsistent. Two serious adverse events were reported with NSAIDs, and 22 deaths, but these were not clearly related to any pain treatment. Common adverse events were thirst/dry mouth (15%), loss of appetite (14%), somnolence (11%), and dyspepsia (11%). Withdrawals were common, mostly because of lack of efficacy (24%) or adverse events (5%). There is no high-quality evidence to support or refute the use of NSAIDs alone or in combination with opioids for the three steps of the three-step WHO cancer pain ladder. There is very low-quality evidence that some people with moderate or severe cancer pain can obtain substantial levels of benefit within one or two weeks.

Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review.

Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.

Management of cancer pain: ESMO Clinical Practice Guidelines

Management of cancer pain: ESMO Clinical Practice Guidelines

Interventional pain management in the palliative care patient

For the majority of patients, cancer pain can be treated using the World Health Organization cancer pain guidelines; however, for 10-20% of patients with advanced cancer, adequate pain control cannot be achieved using these methods owing to disease pathophysiology preventing administration/absorption of pain medications or intolerance due to opioid toxicities. The need to expand analgesic treatment when oral, transdermal, and intravenous therapies fail requires exploration of interventional pain management techniques such as neuraxial (e.g. epidural and intrathecal) infusion therapies and neurolytic interventions. Nurses caring for patients with cancer pain should develop their knowledge of these multimodal approaches to cancer pain management.

The WHO analgesic ladder: 25 years on

British Journal of NursingVol. 20, No. Sup10 CommentThe WHO analgesic ladder: 25 years onGiovambattista ZeppetellaGiovambattista ZeppetellaSearch for more papers by this authorGiovambattista ZeppetellaPublished Online:16 Aug 2013https://doi.org/10.12968/bjon.2011.20.Sup10.S4AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Azevedo São Leão Ferreira K, Kimura M, Jacobsen Teixeira M (2006) The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer 14(11): 1086–93 Epub Crossref, Medline, Google ScholarForbes K (2007) The principles of management of pain due to cancer. http://tinyurl.com/3na8ecd (Accessed 6 September 2011) Google ScholarHanks GW, Hawkins C (2000) Agreeing a gold standard in the management of cancer pain: the role of opioids. In: Hillier RFinlay IWelsh JMiles A. eds, UK Key Advances in Clinical Practice Series 2000. The Effective Management of Cancer Pain. Aesculapius Medical Press, London:57–75 Google ScholarJacox A, Carr DB, Payne R (eds) (1994) Management of cancer pain: clinical practice guideline no 9. AHPCR Publication No. 94-0592). Agency for Health Care Policy and Research, US Department of Health and Human Services, Rockville. Google ScholarJadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 274(23): 1870–3 Crossref, Medline, Google ScholarLevy MH (1996) Pharmacologic treatment of cancer pain. N Engl J Med 335(15): 1124–32 Crossref, Medline, Google ScholarSchrijvers D (2007) Pain control in cancer: recent findings and trends. Ann Oncol 18(9suppl): ix37–42 Medline, Google ScholarStjernswärd J, Colleau SM, Ventafridda V (1996) The World Health Organization Cancer Pain and Palliative Care Program. Past, present, and future. J Pain Symptom Manage 12(2): 65–72 Crossref, Medline, Google ScholarWorld Health Organization (1986) Cancer pain relief. WHO, Geneva Google ScholarWorld Health Organization (1996) Cancer Pain Relief. 2nd edn. WHO, Geneva: Google Scholar FiguresReferencesRelatedDetailsCited byImpact of Epidural Analgesia on Quality of Life and Pain in Advanced Cancer PatientsPain Management Nursing, Vol. 16, No. 3Pain and Suffering in Cancer PatientsModern Believing, Vol. 56, No. 2Musculoskeletal pain in older adults at the end-of-life: a systematic search and critical review of the literature with priorities for future research25 July 2013 | BMC Palliative Care, Vol. 12, No. 1Chancen optimieren, Risiken minimieren15 November 2013 | MMW - Fortschritte der Medizin, Vol. 155, No. 25When Should Nerve Blocks Be Used for Pain Management? 22 September 2011Volume 20Issue Sup10ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 16 August 2013 Published in print 22 September 2011 Information© MA Healthcare LimitedPDF download

International Association for the Study of Pain: Update on WHO-IASP Activities

The International Association for the Study of Pain (IASP), founded in 1972, is a non-governmental organization (NGO) and has an official relationship with the World Health Organization (WHO). IASP and individual IASP members have collaborated with WHO for more than two decades in improved understanding of pain and promoting better availability of pain therapy world wide. The first WHOIASP liaison-officer was Dr. Kathleen Foley. She has had a major impact on the WHO cancer pain and palliative care programs and was one of the driving forces for the expert groups that developed WHO publications and educational resources, such as the booklet WHO Cancer Pain Relief, published in 1986. 1–4

Palliative Care and Hospice Programs

Palliative Care and Hospice Programs

The Management of Pain

The Management of Pain

The World Health Organization cancer pain and palliative care program past, present, and future

The World Health Organization cancer pain and palliative care program past, present, and future

New technique for the neurolytic celiac plexus block: the transintervertebral disc approach.

New technique for the neurolytic celiac plexus block: the transintervertebral disc approach.

Opioid availability in latin america: The declaration of florianopolis

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.