Current oncology reports
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Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. ⋯ We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on cyclooxygenase-2 (COX-2) inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl d-aspartate (NMDA) receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at non-opioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.
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Most terminally ill patients experience symptoms that require treatment as death approaches. The most common symptoms are pain (5% to 51%), dyspnea (28%), oral and respiratory secretions (25%), nausea and vomiting (10% to 14%), confusion (10%), myoclonus (12%), and bowel and bladder problems (over 20%). ⋯ Types of drugs that are important in symptom control include opioids, co-analgesics, anxiolytics, and anticholinergics. To be effective, these medications must be readily available for use and often need to be given by a non-oral route.