Mechanism-based cancer-pain therapy

Abstract

Cancer pain remains prevalent and severe for many patients, particularly in those with advanced disease before they die. The effectiveness of treatment in routine practice appears to have changed little in the last 30 years since publication of the WHO approach.Qualitative studies in patients with advanced cancer suggest that key priorities in pain management strategies should be to help patients achieve a balance between pain and adverse effects of analgesia in order to optimise physical function, and support for selfmanagement.Interventions targeted at physiological, behavioural and health-system mechanisms can improve pain outcomes for patients. Strong opioids have medium to strong effect sizes while most other drug and non-drug interventions have small to medium effect sizes at best. The limitations of current analgesic interventions should encourage greater use of interventions that target patient and healthcare professional behaviour. A framework is proposed for interventions in cancer pain management that target mechanisms and outcomes that are important to patients. This framework might help to broaden management strategies and encourage evidence-based but underused interventions.3

Cancer Pain With a Neuropathic Component: A Cross-sectional Study of Its Clinical Characteristics, Associated Psychological Distress, Treatments, and Predictors at Referral to a Cancer Pain Clinic

“…7 In addition to pharmacologic receptor targeting, the targeting of associated physician and patient behavioral aspects, such as integrating pain assessment data into pain management decisions and the promotion of selfefficacy in patients, have been advocated in a broader mechanistic approach to cancer pain management. 15 Although there has been a relative preponderance of neuropathic pain studies in the noncancer chronic pain populations, the generalizability of their findings to the cancer pain population has limitations. 16 An improved understanding and characterization of the clinical presentation of neuropathic cancer pain is, therefore, an important step in advancing its assessment and management.…”

Access to Opioids for Patients with Advanced Disease

“…Access to pain relief, including in palliative care, is now recognised as a fundamental human right (23,24). A multimodal approach to pain relief at the end of life is increasingly advocated, comprising pharmacological and non-drug interventions (25). Current "best practice" for pharmacological management is generally based upon the World Health Organisation (WHO) analgesic ladder (26, 27), first introduced in 1986.…”

Sustained-Release Hydromorphone Microparticles Produced by Supercritical Fluid Polymer Encapsulation

“…One of the most common symptoms caused by cancer is chronic pain, which is the most feared symptom by patients throughout the course of the disease 1 . The pain may be exacerbated by treatment with chemotherapy drugs or by radiation resulting in poorly alleviated pain complicated by a neuropathic component 2,3 .…”

“…Despite administration of escalating doses of strong opioid analgesics such as morphine, up to 30% of patients do not achieve satisfactory pain relief 4 . The effectiveness of treatment in the clinical setting has changed little in the last 30 years 1,5 . Hence, new strategies are needed to address this issue of intractable cancer-related pain.…”