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Query: UMLS:C0596240 (cancer pain)
 3,066 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper will review what is known about key issues of importance in the clinical use of opioids for the treatment of intractable non-cancer related pain, and will attempt to describe the evolving areas of consensus among clinicians who treat pain and addiction regarding various aspects of use of opioids for the treatment of chronic non-cancer pain.
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PMID:Opioid therapy of chronic pain: assessment of consequences. 1052 38

It is estimated that approximately 50% of patients with cancer experience pain, and this percentage increases to 80% in patients with terminal cancer. Misconceptions and concerns of patients with cancer regarding the use of opioid analgesics have been identified as one of the major barriers to achieving optimal pain control. Misconceptions and concerns regarding addiction and tolerance to opioid analgesics and patients' desire to be "good" have been reported in the United States. The aim of this survey was to determine if similar misconceptions and concerns exist in Hong Kong Chinese patients with cancer. The results indicate that Hong Kong Chinese patients have the same concerns regarding the use of opioid analgesics. The respondents' fatalistic beliefs are a major hindrance to optimizing pain control, with 79% indicating that pain is an inevitable aspect of hospitalization because they believe that cancer pain cannot be relieved by medications. Fear of addiction was a major concern for 52% of the respondents, and about the same number of respondents believed that opioid analgesics should be administered only as a last resort. Regarding a desire to be "good," more patients reported that they would prefer to disturb nurses rather than physicians. It is desirable that culturally specific education programs be provided to dispel patient misconceptions and concerns regarding the use of opioid analgesics.
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PMID:Concerns and misconceptions about pain among Hong Kong Chinese patients with cancer. 1060 87

In the last decade there has been significant controversy about the appropriateness, efficacy, safety, and wisdom of treating chronic pain patients (CPPs) with opioids. Arguments against their use have included concerns about tolerance, dependence, addiction, persistent side effects, and interference with physical or psychosocial functioning. However, considerable experience and research with long-term cancer pain treatment suggests that in appropriately selected patients, opioids have a low morbidity, and a low addiction potential, and in addition to the primary analgesic action, can facilitate reduction in suffering, enhance functional activity level, and improve quality of life without significant risk of addictive behaviors. Some patients, however, are at risk. Risk factors for addiction are discussed in this article.
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PMID:Opioids in chronic pain management: is there a significant risk of addiction? 1099 22

Physicians involved in cancer pain management treat thousands of patients with opioids, whose effective analgesia improves overall functioning. Side effects generally are tolerable, and treatment can be maintained with stable doses for long periods. Problems with addiction are infrequent. Many physicians, however, assume that opioids should be used only for chronic malignant pain. Research and clinical experience have demonstrated that opioids can safely and effectively relieve most chronic moderate to severe nonmalignant pain. Fears of addiction, disciplinary action, and adverse effects result in ineffective pain management. With current information on the use of opioids in chronic nonmalignant pain, primary care physicians can overcome these obstacles. Guidelines must clearly define the role of the primary care physician in the proper management of pain and the integration of opioid therapy. Used appropriately, opioids may represent the only source of relief for many patients.
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PMID:Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids. 1101 58

Methadone is currently best known for its use as the maintenance drug in opioid addiction. The main concern when using methadone for the treatment of pain is its long and unpredictable half-life, which is associated with the risk of delayed toxicity. This may result in side effects such as sedation and respiratory depression if careful titration and close observation of individual patient responses are not performed. For this reason, methadone is often viewed as a second line opioid, after other opioids with a more predictable dose-response have been tried. We report six patients with long-term exposure to methadone as a treatment for heroin dependency, who were also treated with methadone for cancer pain. The first five patients were at least partially refractory to the analgesic effects of opioids other than methadone. All six patients achieved analgesia without sedation or respiratory depression from aggressive upward methadone titration. Methadone analgesia can be considered early in the course of treatment of patients with chronic exposure to methadone who develop new or worsening pain requiring opioid therapy.
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PMID:Methadone analgesia in cancer pain patients on chronic methadone maintenance therapy. 1122 67

The success of the WHO guidelines for the treatment of cancer pain indicates that cancer pain was previously undertreated. At the heart of these guidelines lies the three-step analgesic ladder, the last two steps of which consist of prescribing opioids. Today, the use of opioids in cancer patients is generally accepted, but there are still some concerns over the risks of addiction and adverse reactions, and opioids are sometimes withheld from patients who would otherwise benefit from them. However, it has been shown that such concerns are misplaced: the risks of severe adverse reactions and addiction are low when opioids are used correctly in patients with chronic pain. The use of opioids to treat benign pain is even less widely accepted in many countries, despite recommendations that they should be prescribed. It is emphasized that the use of opioids is a valid option for treating benign pain, and they should not be withheld from patients who need them. Opioids are always indicated when other therapeutic options, including NSAIDs, have failed or are contraindicated. When opioids are prescribed, procedures should be followed to provide the patient with maximum benefit and minimum risk.
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PMID:The lesson from cancer pain. 1131 Apr 80

There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.
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PMID:Opioids in non-cancer pain: a life-time sentence? 1155 90

Indications for strong opioids for cancer-related pain as well as for chronic non-cancer pain are that non-opioid drugs, and other less risky therapies, fail and that the pain is opioid-sensitive. The WHO analgesic ladder principle continues to serve as an excellent educational tool in the efforts by WHO in collaboration with the World Federation of Societies of Anaesthesiologists (WFSA) and The International Association for the Study of Pain (IASP) to increase knowledge of pharmacological pain therapy and increase availability of essential opioid analgesics world-wide. Opioids differ in pharmacodynamics and pharmacokinetics, and patients have different pharmacogenetics and pain mechanisms. Sequential trials of the increasing numbers of available opioid drugs are therefore appropriate when oral morphine fails. Controversies continue concerning diagnosis and handling of opioid-insensitive pain in cancer and chronic non-cancer pain, opioid-induced neurotoxicities, risks of tolerance, addiction, pseudo-addiction, and methods for improving effectiveness and decreasing adverse effects of long-term opioid therapy, treating breakthrough pain with immediate release oral and transmucosal opioids. Consensus guidelines have recently been developed in the Nordic countries concerning the ethical practice of palliative sedation when opioids and other pain-relieving therapies fail in patients soon to die. Guidelines for long-term treatment with strong opioids of chronic non-cancer-related pain are also being developed in the Nordic countries, where very diverging traditions for the usage of such therapy still exist.
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PMID:Opioids in cancer and chronic non-cancer pain therapy-indications and controversies. 1168 53

Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs. The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.
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PMID:A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients. 1172 34

China is a large country with a huge population. It is estimated that 1.8 million patients suffer initially from cancer and 1.4 million patients die from it each year in Mainland China. Cancer ranks as the primary reason for death among the common diseases in cities and the second in rural areas. The management of pain is still a critical issue in the care of patients both with cancer and non-cancer pain. A national survey suggested that the fear of addicting patients was still a major barrier for medical professionals in prescribing opioid analgesics. The major reasons for poor management or negative factors of pain relief came from patients' own reasons including their over-concern about addiction to opioid analgesics, their reluctance to report pain and their resistance to use opioid analgesics. Oral long-acting opioids are the most commonly used drugs for third ladder pain management. With policy support from the government, the consumption of morphine for medical purposes has increased significantly for the first time in recent Chinese history as this new cancer pain relief policy has been developed in the country. As a result, the three-step analgesic ladder of the World Health Organization (WHO) has been gradually accepted by medical personnel and patients. Although pain management has been improved since the WHO's strategy of the three-step approach was implemented in China, variations still exist in different regions of the Mainland. Currently the three main aspects of work on pain measurement are going to be undertaken including (1) continuous support from government policy; (2) consistent education and training; and (3) better availability of drugs for medical use throughout the whole country.
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PMID:Current status of pain management in China: an overview. 1179 21


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