No cancer patient should live or die with unrelieved pain!
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- The World Health Organization (WHO) estimates that by 2021, there will be 20 million new cases of cancer worldwide per year; approximately 70% occurring in developing countries
- In patients with advanced cancer, pain is described as moderate to severe in approximately 40%–50% and as very severe in 25%–30%.
- New treatments increase survival rates which results in cancer patients living longer with pain from the disease and its treatment. Indeed, there may be situations where the cancer has been cured while the chronic pain disease still persists.
Sources of Cancer Pain
- Pain due to cancer is complex and its treatment should be individualized in order to achieve the maximum effect
- There are four basic approaches to cancer pain control:
- Modification of the source of pain
- Alteration of central perception
- Modulation of transmission to the central nervous system
- Blockade of transmission of pain to the central nervous system
- Systemic pharmacologic management aimed at the first three of these approaches is the cornerstone of the treatment of most cancer patients with moderate to severe pain.
- Optimal pharmacologic management of cancer pain requires:
- Selection of the appropriate analgesic drug
- Prescription of the appropriate dose
- Administration of the analgesic by the appropriate route
- Scheduling of the appropriate dosing interval
- Prevention of persistent pain and relief of breakthrough pain
- Aggressive dose titration
- Prevention, anticipation, and management of analgesic side effects
- Consideration of sequential trials of opioid analgesics
- Use of appropriate co-analgesic drugs for specific pain syndromes
- Most clinicians should be able to control most of the pain in most of their cancer patients, in about 15 % of cases an interdisciplinary Pain Management Clinic will be required)
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