Abstract
In the last decades, studies validating the WHO analgesic ladder have been shown to have methodological limitations and different problems are unresolved due to a lack of controlled studies on this subject. These problems include a better definition of the role of NSAIDs, the prolonged use of NSAIDs in cancer pain, and the utility of step 2. Moreover, the indications for using different strong opioids and alternate routes of administration to improve pain relief in difficult pain situations are not well established. The proportion of patients who do not benefit from these treatments remain unclear, and how the opioid response may be improved with the use of adjuvants is also uncertain. This review will offer an update on these problems and the existing therapeutic opportunities.
Similar content being viewed by others
References
Benitez-Rosario M, Salinas-Martin A, Aguirre-Jaime A, Perez-Mendez L, Feria M (2009) Morphine–methadone opioid rotation in cancer patients: analysis of dose predicting factors. J Pain Symptom Manage 37:1061–1068
Caraceni A, Zecca E, Bonezzi C et al (2004) Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol 22:2909–2917
Cleeland CS, Gonin R, Hatfield AK et al (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596
Cherny NJ, Chang V, Frager G et al (1995) Opioid pharmacotherapy in the management of cancer pain. Cancer 76:1288–1293
Cherny N, Ripamonti C, Pereira J et al (2001) Expert Working Group of the European Association of Palliative Care Network Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19:2542–2554
De Conno F, Ripamonti C, Fagnoni E, Brunelli C, Luzzani M, Maltoni M, Arcuri E, Bertetto O, MERITO Study Group (2008) The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during ‘titration phase’ in patients with cancer pain. Palliat Med 22:214–221
Eisenberg E, Berkey C, Carr DB, Mosteller F, Chalmers C (1994) Efficacy and safety of non steroidal antinflammatory drugs for cancer pain: a meta-analysis. J Clin Oncol 12:2756–2765
Grape S, Schug SA, Lauer S, Schug BS (2010) Formulations of fentanyl for the management of pain. Drugs 70:57–72
Grond S, Radbruch L, Meuser T et al (1999) High-dose tramadol in comparison to low-dose morphine for cance`r pain relief. J Pain Symptom Manage 18:174–179
Hanks GW, De Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593
Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. JAMA 274:1870–1873
Marinangeli F, Ciccozzi A, Leonardis M et al (2004) Use of strong opioids in advanced cancer pain: a randomized trial. J Pain Symptom Manage 27:409–416
McNicol E, Strassels S, Goudas L, Lau J, Carr D (2004) Nonsteroidal anti-inflammatory drugs, alone or combined with opioids, for cancer pain: a systematic review. J Clin Oncol 22:1975–1992
Mercadante S, Salvaggio L, Dardanoni G, Agnello A, Garofalo S (1998) Dextropropoxyphene versus morphine in opioid-naïve cancer patients with pain. J Pain Symptom Manage 15:76–81
Mercadante S (1999) Pain treatment and outcome in advanced cancer patients followed at home. Cancer 85:1849–1858
Mercadante S (1999) Opioid rotation in cancer pain rationale and clinical aspects. Cancer 86:1856–1866
Mercadante S, Arcuri E, Tirelli W, Villari P, Casuccio A (2002) Amitriptyline in neuropathic cancer pain in patients on morphine therapy: a randomized placebo-controlled, double-blind crossover study. Tumori 88:239–242
Mercadante S, Fulfaro F, Casuccio A (2002) A randomised controlled study on the use of anti-inflammatory drugs in patients with cancer on morphine therapy: effect on dose-escalation and pharmacoeconomic analysis. Eur J Cancer 38:1358–1363
Mercadante S, Porzio G, Ferrera P et al (2006) Low morphine dose in opioid-naïve cancer patients with pain. J Pain Symptom Manage 31:242–247
Mercadante S, Bruera E (2006) Opioid switching: a systematic and critical review. Cancer Treat Rev 32:304–315
Mercadante S, Porzio G, Ferrera P et al (2008) Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. Eur J Pain 12:1040–1046
Mercadante S (2007) Opioid titration in cancer pain: a critical review. Eur J Pain 11:823–830
Mercadante S, Ferrera P, Villari P et al (2009) Frequency, indications, outcomes, and predictive factors of opioid switching in an acute palliative care unit. J Pain Symptom Manage 37:632–641
Mystakidou K, Tsilika E, Kouloulias V et al (2003) Long-term cancer pain management in morphine pre-treated and opioid naïve patients with transdermal fentanyl. Int J Cancer 107:486–492
Mystakidou K (2004) Pain management of cancer patients with transdermal fentanyl: a study of 1828 step I, II & III transfers. J Pain 5:119–132
Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence, and characteristics. Pain 41:273–281
Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi F (1987) A validation study of the WHO method for cancer pain relief. Cancer 59:850–856
Vielvoye-Kerlmeer A, Mattern C, Uitendaal M (2000) Transdermal fentanyl in opioid-naïve cancer patients: an open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naïve patients and a group using codeine. J Pain Symptom Manage 19:185–192
World Health Organization (1990) Cancer pain relief and palliative care. WHO, Geneva
Zech DFJ, Grond S, Lynch J, Hertel D, Lehmann KA (1995) Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mercadante, S. Management of cancer pain. Intern Emerg Med 5 (Suppl 1), 31–35 (2010). https://doi.org/10.1007/s11739-010-0448-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-010-0448-8