Therapie
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Cancer pain in general responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment, successfully controlling pain in 70 to 90% of patients. Some pains do not respond so well but can usually be ameliorated by the judicious use of adjuvant analgesics, non-drug measures and the active involvement of the multi-disciplinary team.
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It is commonly recognized than opioids analgesics have an major place in the treatment of pain. In spite of guidelines, opioids drugs remain underutilized in chronic cancer pain and acute severe pain. Among the possible factors, involved in the insufficient use of opioids drugs, is the fear (opiophoby) of physicians, nurses, patients and family to induce or to maintain an addiction. ⋯ We will examined the place of morphine-like drugs in the treatment of severe acute pain and chronic cancer pain, the definition of dependency in pain patients, the assessment of the dependency potential in patients treated for pain. Available studies indicate that iatrogenic addiction is quite scarce and that the risk for a major tolerance is very small. Further studies will be necessary, since opioids analgesics may also be useful in some non-cancer chronic pain.
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Several drugs and techniques have been developed to improve the quality of post operative analgesia. Opiates are always the first intention drugs, specially with new molecules (buprenorphine, nalbuphine ...). ⋯ The alpha 2 adrenergic agonists use must be specify. The patient auto-controlled administration and the transdermal administration of opiates are useful techniques to provide effective analgesia with optimal safety.