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Current concepts of pain management for cancer patients

Yin-Hsun Feng, Ying-Wai Wang, Sai-Ching Jim Yeung
  • Yin-Hsun Feng
    Chi-Mei Medical Center, Liouying Campus; Institute of Clinical Medicine, Medical School, National Cheng Kung University, Tainan, Taiwan, Province of China | syeung@mdanderson.org
  • Ying-Wai Wang
    Hospice Unit, Tzu Chi University, School of Medicine, Hualien, Taiwan, Province of China
  • Sai-Ching Jim Yeung
    Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M.D. Anderson Cancer Center, Holcombe Houston, United States

Abstract

Pain management is one of the most important issues confronted when treating patients with malignant diseases. Since its release/publication in 1986, the World Health Organization’s three-step analgesic ladder has helped to greatly improve pain management in cancer patients. However, many questions about this three-step analgesic ladder have been raised and its application in the clinical setting remains a controversial subject. This review article explores the frontline treatment of cancer pain with morphine and the different routes of fentanyl administration used in cancer pain management. The combination of multiple opiates/opioids has been shown to result in more effective cancer pain management; however, the exact benefits of such opiate/opioid combinations have yet to be established. This article also discusses recent advances in the topical application of morphine and in the combination of ketamine and morphine. It explores the updated treatment principles of neuropathic pain in advanced-stage cancer patients, which incorporate the use of anti-depressants, anti-convulsants, and opioids. Finally, this article reviews the available data and clarifies the general principles for using opioids in cancer patients with renal insufficiency. We hope that this information will be helpful in improving pain management in cancer patients and in facilitating further research.

Keywords

Cancer pain - WHO analgesic ladder - Opiate - Side effect

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Submitted: 2011-12-15 16:27:29
Published: 2011-12-15 00:00:00
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Copyright (c) 2011 Yin-Hsun Feng, Ying-Wai Wang, Sai-Ching Jim Yeung

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