Latin-American Guidelines for Cancer Pain Management

Abstract

Practice points• Adequate pain management starts with an appropriate syndromic diagnosis based on a detailed clinical history, comprehensive physical examination and correct interpretation of additional medical tests.• Appropriate syndromic classification of pain is based on its clinical characteristics, as well as on a meticulous assessment of the intensity of pain by applying standard scales. The patient's psychosocial situation must be taken into account when attempting to optimize management and predict the response to treatment.• As with all types of chronic pain, assessment of patients with cancer pain should take into account the individual profile of the patient (age, comorbidities, functionality, previous exposure to drugs such as opioids and polypharmacy) and the type, intensity and potential clinical course of the pain. Only thus will it be possible to decide on the best approach, based on aspects such as efficacy, safety, tolerability and cost. Multimodal strategies are the most successful.• Multimodal approaches include interventional, psychological, rehabilitative and integrative therapies.• Various formulations of fentanyl have been reported for the treatment of breakthrough pain, as follows: transmucosal, intranasal, sublingual, buccal tablets and gingival. However, these formulations are not available in Latin America.• In Latin America, the WHO guidelines have proven critical for justifying to local governments the key role of opioids such as morphine and the need for an adequate supply. Nevertheless, availability of opioids in the region remains poor.• Treatment of severe pain should be with a strong opioid, in most cases with oral formulations. Other routes (intravenous, subcutaneous, spinal (epidural and intrathecal) may only be necessary in refractory cases.• Extended-release opioids (morphine, oxycodone and hydromorphone) can be supplemented with immediate-release formulations as needed. Assessment of comorbidities is essential when deciding on the best option.For reprint orders, please contact: reprints@futuremedicine.com

Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial

“…Approximately 70% of patients with cancer pain are undertreated internationally [18] because physicians cannot access patients’ current pain status, which is how physicians determine whether to change analgesic treatment, so the real-time messaging providing by the app plays the most important role in cancer pain management. If the drug adverse reaction and BTcP could not be treated timely and adequately, cancer pain may progress to a pain crisis [3]. An innovative real-time pain assessment mechanism and electronic reporting system were considered to be more effective in capturing pain data [19,20].…”

“…Previous reports show that the incidence of pain is 30% to 50% in patients with early and midstage cancer and 75% to 90% in patients with advanced cancer [2]. Pain devastates the quality of life (QoL) of patients with cancer, impedes cancer recovery, interferes with activities of daily living, and results in long-term morbidity [3]. Poor pain management places a huge emotional burden on patients and their relatives and represents a significant cost burden to the health care system and families, with pain being the most common reason for patients with cancer to use emergency health services [4].…”

Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications

“…Cancer patients often report intense pain, leading to a lower performance status [88]. Pain might be related to tumor localization, but it can also arise due to chemotherapy treatment and/or surgery [89]. Notably, cancer pain comprises inflammatory and neuropathic mechanisms in virtue of tumor mass development [90].…”

Drug utilization review of tramadol hydrochloride in a regional hospital in South Africa; findings and implications

“…Its analgesic properties can be improved by combining it with non-opioid analgesics (2). Initially, tramadol HCl was perceived to have a lower side-effect profile compared to other opioids and a lower dependency compared with morphine (5)(6)(7)(8). As a result, tramadol HCL has been widely used in lower-and middle-income countries especially as it is often the only analgesic available for patients with moderate to severe pain, there are concerns with the use of opiods and non-steroidal anti-inflammatory drugs (NSAIDs) in these patients, as well as being relatively inexpensive despite not being on the World Health Organisation's (WHO) essential medicine list (EML) (6,8,9).…”