Cancer pain management
Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.
Pain affects ~55% of patients during treatment and ~66% with advanced disease. The WHO analgesic ladder (1986) established oral morphine as the core; modern practice adds mechanism-based adjuvants (dexamethasone, gabapentinoids, duloxetine for chemotherapy-induced neuropathy per CALGB 170601, ketamine, cannabinoids with weak evidence), bone-directed therapy (single-fraction radiotherapy, bisphosphonates/denosumab, radiopharmaceuticals), interventional procedures (coeliac plexus neurolysis for pancreatic cancer, vertebroplasty, intrathecal drug delivery, cordotomy), and non-pharmacologic approaches. Opioid stewardship balances the US overdose epidemic (which reduced cancer patients' access) against the ~80% of the world's population with essentially no morphine access. Cancer survivors with chronic pain need distinct guidance (ASCO 2016).
How it works
Assess pain type (nociceptive, neuropathic, bone, visceral) and intensity; treat cause (radiation, surgery, systemic therapy) and symptom in parallel with a stepped, mechanism-based regimen and regular reassessment.
- Oral morphine is cheap, effective and on the WHO essential list
- Single-fraction radiotherapy relieves bone pain in ~60%
- Interventional options for refractory pain
- Global opioid access inequity
- Opioid-related stigma and regulation
- Chemotherapy-induced neuropathy has one moderately effective drug (duloxetine)
Latest papers
topQuery for this technology: (TITLE:"Cancer pain management" OR ABSTRACT:"Cancer pain management") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Cancer pain management, not a curated reading list.
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