Controversies in pharmacotherapy of pain management

Since the establishment of the WHO three-step ladder for management of cancer pain, several controversies have arisen, which are partly due to new drug development, reformulations of older analgesics, and technological advancements. As a result, clinicians need clarification of several questions. Is...

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Bibliographic Details
Published in:The lancet oncology 2005-09, Vol.6 (9), p.696-704
Main Authors: Davis, Mellar P, Walsh, Declan, Lagman, Ruth, LeGrand, Susan B
Format: Article
Language:English
Subjects:
Analgesics
Analgesics - administration & dosage
Analgesics - therapeutic use
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Antidepressants
Bisphosphonates
Bone and Bones
Breast cancer
Cyclooxygenase Inhibitors - therapeutic use
Diphosphonates - therapeutic use
Drug dosages
Fentanyl
Humans
Metabolites
Methadone
Morphine
Multiple myeloma
Narcotics
Neoplasms - complications
Neuralgia - drug therapy
Pain - drug therapy
Pain - etiology
Pain management
Pharmacokinetics
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Summary:Since the establishment of the WHO three-step ladder for management of cancer pain, several controversies have arisen, which are partly due to new drug development, reformulations of older analgesics, and technological advancements. As a result, clinicians need clarification of several questions. Is morphine the opioid of choice for moderate to severe pain in cancer? Should combinations of opioids be used? When should spinal opioids be used to treat pain in cancer? What are the appropriate opioid doses for breakthrough pain? Should selective cyclo-oxygenase (COX) 2 inhibitors be used? What is the best tactic to treat neuropathic pain, and what first-line adjuvant analgesic should be used? And do bisphosphonates relieve bone pain in cancers other than breast cancer and myeloma? This review addresses these questions.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(05)70317-X