cancer pain:

In recent years, it has become evident that the appropriate assessment of a patient with cancer pain requires a multi-dimensional evaluation of the pain syndrome - the patient's clinical and psychological characteristics, and a number of specific prognostic factors that have a major impact on the treatment outcome and might help focus the care. It has also become apparent that pain should be considered in the context of other major symptom complexes that are also highly prevalent in patients with advanced cancers.

ANALGESIC LADDER APPROACH:

An analgesic ladder approach to the selection of analgesic drugs for cancer pain has been developed by the CANCER PAIN RELIEF AND PALLIATIVE CARE PROBLEM OF WHO (1996). Patients with mild to moderate pain are usually first treated with acetaminophen or NSAIDS. This drug is combined with one or more adjuvants if a specific indication for one exists. These adjuvants drugs include drugs selected to treat a side effect of the analgesic (e.g. laxatives) and drugs with analgesic effects.

The role of morphine in the management of chronic pain has also evolved with recognition of its active metabolites.

Based on clinical experience, there are a few guidelines for the selection of an opioid as an alternative to morphine. Patients with severe pain, who require rapid dose titration, are generally best treated with drugs that approach steady state after treatment is initiated or the dose is changed. Controlled - release drugs, including the long-lasting morphine and oxycodone preparations and the transdermal fentanyl system, can require up to several days to approach steady-state concentrations and are usually not preferred in this setting.

Non-Opioids: (NSAIDS, Acetaminophen), useful for bone pain, soft tissue pain, dysmenorrhea. May be added at step one and continued on all 3 steps of the ladder.