Articles: neuropathic-pain.
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Many studies have demonstrated that cancer pain can be relieved in most cases by suitable analgesic medication. Patients with a diagnosis of "intractable cancer pain", however, are referred to our pain clinic nearly every day. A retrospective study of 1140 patients was therefore performed to evaluate the pain mechanisms and whether analgesic pretreatment had been adequate. ⋯ The principal causes for the inadequacy of the analgesic pretreatment were: failure to prescribe analgesics (10% of the patients), irregular intake schedule or prolonged intervals between applications (66%), underdosage of nonopioid analgesics (27%) or opioids (42%), and withholding of nonopioid analgesics (30%), strong opioids (14%), or co-analgesic drugs (17%), although their prescription was indicated. The severe pain was thus caused in many patients by simple mistakes in the prescription of analgesics. Terms like "intractable" should be used with caution when referring to cancer pain because they are often unreflected and can make patients and physicians feel helpless or insecure.
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Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. ⋯ Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain -therefore, they should be given "by the clock". Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.