Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Abstract

Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.

Anesthesia and Analgesia In War and Terror Injuries

“…Multimodal yaklaşım, farklı etki mekanizmalarına sahip basit doz analjeziklerin yanı sıra opioidler ve adjuvanlar kullanılarak düzenli dozlar kullanılmasını içerir. Dünya Sağlık Örgütü (WHO) ağrı merdiveni ağrı derecesi arttıkça, ağrı kesici koşullarda basit analjezikler ve opioidlerindozajlanması için genel kabul gören yaklaşımı anlatmaktadır (39) . Bu yaklaşım, multimodal analjezinin temelini oluşturmaktadır.…”

Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

“…The guideline recommends that clinicians provide adults and children with acetaminophen and/or nonsteroidal antiinflammatory drugs (NSAIDs) as part of multimodal analgesia for management of postoperative pain in patients without contraindications (5). NSAIDs inhibit prostaglandin synthesis pathway results in a reduction in pain and inflammation and thereby reduce nociceptive stimuli (6). Acetaminophen is indicated for the short-term treatment of mild to moderate pain or fever (7).…”

Updates in palliative care – overview and recent advancements in the pharmacological management of cancer pain

“…3 Although there is some evidence supporting the use of WHO recommendations in treating cancer pain, there is a lack of randomised controlled trial (RCT) data. 4 Nonetheless, opioids such as codeine, morphine, oxycodone and fentanyl are often used in conjunction with paracetamol +/-NSAIDs and coanalgesics (adjuvants) to manage cancer pain. Other treatment modalities outside the WHO analgesic ladder (including interventional techniques like nerve blocks or intrathecal analgesia delivery) are also endorsed in the original WHO recommendations.…”

“…Other treatment modalities outside the WHO analgesic ladder (including interventional techniques like nerve blocks or intrathecal analgesia delivery) are also endorsed in the original WHO recommendations. 4 In order to gain maximum benefit from these therapeutic options, they should be considered alongside the WHO analgesic ladder for patients likely to require them, rather than as a final step. 4 …”

“…4 In order to gain maximum benefit from these therapeutic options, they should be considered alongside the WHO analgesic ladder for patients likely to require them, rather than as a final step. 4 …”