The Medical clinics of North America
-
Med. Clin. North Am. · Mar 1987
ReviewAnalgesic drug therapy in cancer pain: principles and practice.
Drug therapy represents the mainstay of treatment for patients with cancer pain. Non-narcotic, narcotic, and adjuvant analgesics are the commonly used agents. The choice of a specific analgesic drug regimen is dependent on the type of pain and its severity, and the drug must be titrated to the individual needs of the patient.
-
The anatomy, physiology, and pharmacology of nociception and its modification by analgesic drugs have been studied extensively in the past decade. Although the neural mechanisms of nociceptors and the stimuli that activate them are much better understood, it must be emphasized that the perception of pain, as well as the meaning of pain to the individual, is a complex behavioral phenomenon and involves psychologic and emotional processes in addition to activation of nociceptive pathways. Pain related to malignant disease can be classified as somatic, visceral, and deafferentation in type. ⋯ Although incompletely understood, the pathophysiology of deafferentation pain appears to be different from that of somatic or visceral pain, and the treatment approaches may be different. Management approaches to deafferentation pain usually emphasize treatment of the pain, because injury to the nervous system may be difficult to reverse, even if one can successfully treat the underlying malignancy, and many deafferentation pain syndromes occur as a complication of cancer therapy. The role of narcotic analgesics in the management of deafferentation pain is not clear, although the published experience suggests that they are less useful than in somatic or visceral pain.
-
Med. Clin. North Am. · Mar 1987
ReviewRole of epidural and intrathecal narcotics and peptides in the management of cancer pain.
The spinal administration of opioids may provide analgesia of long duration to patients with bilateral or midline lower abdominal or pelvic cancer pain. However, cross-tolerance to orally and parenterally administered narcotics and the rapid development of tolerance to spinal narcotics have limited their usefulness. ⋯ Further clinical and pharmacokinetic studies are required to provide the information regarding: the optimal opioids for use as spinal analgesics; equieffective dose ratios of spinal opioids in comparison to parenteral or oral opioids; strategies useful to forestall the development of tolerance of spinally administered opioids; the analgesic efficacy of this therapy in opioid-tolerant patients; and the role of spinally administered nonopioid analgesics in the management of cancer pain in the tolerant patient. These questions will need resolution before this therapy can be recommended for routine use in the management of cancer pain.
-
Med. Clin. North Am. · Mar 1987
ReviewAntitumor and antinociceptive approaches to control cancer pain.
Patients with cancer pain often present with specific clinical syndromes that allow specific anti-tumor approaches. If these approaches are not feasible, neurosurgical procedures for pain relief should be considered. ⋯ The most durable pain procedure is cordotomy, while intraspinal narcotics offer a rational treatment alternative in selected patients. Spinal and plexopathy syndromes that are amenable to more specific anti-tumor therapy should be looked for, since newer surgical approaches offer the prospect of both pain relief and tumor control.