Validation of World Health Organization guidelines for pain relief in head and neck cancer. A prospective study.

The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

“…Codeine [10,15,16,27,44,48,59] Dextropropoxyphene [27,48,52] Dihydrocodeine [37,59] Oxycodone [44,48] Propoxyphene The studies had either short [41] or variable follow-up periods [15,17,48]. The reasons for termination of the survey were death [16,17,26,27,29,38,42,48,54,59], freedom from pain [15,29,42,59], low compliance [15,27,29,42], treatment continued by practitioner or in another hospital [15,16,29,42,59], loss of follow-up or contact (drop out) [13,15,16,27,29,38,42,54,59], n...…”

“…The reasons for termination of the survey were death [16,17,26,27,29,38,42,48,54,59], freedom from pain [15,29,42,59], low compliance [15,27,29,42], treatment continued by practitioner or in another hospital [15,16,29,42,59], loss of follow-up or contact (drop out) [13,15,16,27,29,38,42,54,59], no need of further therapy [16], change of therapy to other methods (e.g., neurolytic blocks, epidural or parenteral opioids, etc.) [38] and/or discharge from the program [54].…”

“…Some studies (Table 2) used drugs other than those recommended by WHO guidelines [55,56], such as dipyrone [metamizol] [15-17, 29, 37, 38, 42, 59] and flurbiprofen [15-17, 29, 42, 59] in the first step; oxycodone [44,48] and tilidine [15,16,59] in the second step, although oxycodone was considered a third-step drug in the WHO ladder [56]; fentanyl [10,27,41,59], ketobemidon [41], piritramide [15], and sufentanil [41] in the third step ( Table 2). In all reports, the analgesic drugs were associated with adjuvant drugs, if necessary.…”

“…In all reports, the analgesic drugs were associated with adjuvant drugs, if necessary. WHO did not recommend some adjuvant drugs used, such as the antidepressants citalopram and nortriptyline [41]; the anticonvulsants clonazepam [16,17,29,42] and phenytoin [48,54]; and the corticosteroid medroxiprogesterone [48].…”

“…Step 1 Acetaminophen [10,15,16,27,44,48,52,54,59] Pain due to inflammation [29] Aspirin [37,44,48,59] Diclofenac [15,16,27,37,59] Dipyrone[Metamizol] [15-17, 29, 37, 38, 42, 59] Flurbiprofen [15-17, 29, 42, 59] Ibuprofen [27] Ketarolac [27] Naproxen [17,27,29,42,54,59] Step 2…”