Skip to main content

Part of the book series: Cancer Growth and Progression ((CAGP,volume 13))

  • 1162 Accesses

Abstract

Cancer is one of the most debilitating and deadly diseases that, broadly speaking, shows no preference for demographic, sex, age, or culture. It is the second leading cause of mortality of all Americans as a single disease [1], and the sheer potential for mortality from cancer can be a horrifying experience for anyone bearing this diagnosis. Pain is probably one of the most common of all cancer symptoms and can be very frightening for patients and their families. According to statistics published by the American Cancer Society in 2002 [2], 50–70% of patients with cancer experience pain, which usually only intensifies as the disease progresses. It was estimated that less than half of cancer patients get adequate relief of their pain, and 25% actually die in pain [3]. This is particularly disappointing because the pain endured by 90% of these patients could have been well managed with relatively simple interventions [4]. This chapter will discuss different options for treating cancer pain focusing on the pharmacological agents and surgical modalities currently available for pain management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Centers for Disease Control and Prevention (2007) Leading causes of death reports. CDC Report website. http://www.cdc.gov/nchs/fastats/lcod.htm

  2. American Cancer Society (2002) Cancer facts and figures 2002, p 41

    Google Scholar 

  3. AHCPR (1994) Clinical practice guideline #9: management of cancer pain. (Publication #94-0592). Department of Health and Human Services, Washington, DC

    Google Scholar 

  4. Friedman LL, Rodgers PE (2004) Pain management in palliative care. Clin Family Pract 6(2):371

    Article  Google Scholar 

  5. Valdimarsdottir U et al (2002) The unrecognized cost of cancer patients’ unrelieved symptoms: a nationwide follow-up of their surviving partners. Br J Cancer 86:1540–1545

    Article  CAS  PubMed  Google Scholar 

  6. Winslow M, Seymour J, Clark D (2005) Stories of cancer pain: a historical perspective. J Pain Symptom Manage 29(1):22–31

    Article  PubMed  Google Scholar 

  7. Zorza R, Zorza V (1980) A way to die. Andre Deutsch, London

    Google Scholar 

  8. Cherny NJ (2000) The management of cancer pain. CA Cancer J Clin 50:70–116

    Article  CAS  PubMed  Google Scholar 

  9. Noble B et al (2005) The measurement of pain, 1945–2000. J Pain Symptom Manage 29:14–21

    Article  PubMed  Google Scholar 

  10. National Comprehensive Cancer Network (2000) NCCN practice guidelines for cancer pain. Oncology 14:135–150

    Google Scholar 

  11. Turk DC, Monarch ES, Williams AD (2002) Cancer patients in pain: considerations for assessing the whole person. Hematol Oncol Clin North Am 16:511–525

    Article  PubMed  Google Scholar 

  12. Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14:9–17

    CAS  PubMed  Google Scholar 

  13. WHO (1986) Cancer pain relief. World Health Organization, Geneva

    Google Scholar 

  14. Vielhaber A, Portenoy RK (2002) Advances in cancer pain management. Hematol Oncol Clin North Am 16:527–541

    Article  PubMed  Google Scholar 

  15. Lussier D, Huskey AG, Portenoy RK (2004) Adjuvant analgesics in cancer pain management. Oncologist 9:571–591

    Article  CAS  PubMed  Google Scholar 

  16. Dunn MJ (1984) Nonsteroidal anti-inflammatory drugs and renal function. Ann Rev Med 35:411–428

    Article  CAS  PubMed  Google Scholar 

  17. Rouff G, Lema M (2003) Strategies in pain management: new and potential indications for COX-2 specific inhibitors. J Pain Symptom Manage 25(Suppl):S21–S31

    Article  Google Scholar 

  18. Morales E, Mucksavage JJ (2002) Cyclooxygenase-2 inhibitor-associated acute renal failure: case report with rofecoxib and review of the literature. Pharmacotherapy 22:1317–1321

    Google Scholar 

  19. Bombardier C et al (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Eng J Med 343:1520–1528

    Article  CAS  Google Scholar 

  20. Mukherjee D, Nissen SE, Topol EJ (2001) Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 286:954–959

    Article  CAS  PubMed  Google Scholar 

  21. Merck (2004) Merck announces voluntary worldwide withdrawal of VIOXX®. News release. Whitehouse Station, NJ. http://www.vioxx.com/vioxx/documents/english/vioxx_press_release.pdf

  22. Singh D (2004) Merck withdraws arthritis drug worldwide. BMJ 329:816

    Article  PubMed  Google Scholar 

  23. Fitzgerald GA (2004) Coxibs and cardiovascular disease. N Engl J Med 351:17

    Article  Google Scholar 

  24. Silverstein FE et al (2000) Gastrointestinal toxicity with celecoxib vs. nonsteroidal anti- inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib long-term arthritis safety study. JAMA 284:1247–1255

    Article  CAS  PubMed  Google Scholar 

  25. Grond S et al (1999) High-dose tramadol in comparison to low-dose morphine for cancer pain relief. J Pain Symptom Manage 18:174–179

    Article  CAS  PubMed  Google Scholar 

  26. Gutstein HB, Akil H (2001) Opioid analgesics. In: Hardman JG, Limbrid E (eds) Goodman and Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York, pp 569–619

    Google Scholar 

  27. Fukshansky M, Are M, Burton AW (2005) The role of opioids in cancer pain management. Pain Pract 5(1):43–54

    Article  PubMed  Google Scholar 

  28. Hagen NA et al (2005) Efficacy, safety, and steady-state pharmacokinetics of once-a-day controlled-release morphine (MSContinXL) in cancer pain. J Pain Symptom Manage 29:80–90

    Article  CAS  PubMed  Google Scholar 

  29. Donnely S et al (2002) Morphine in cancer pain management: a practical guide. Support Care Cancer 10:13–35

    Article  Google Scholar 

  30. Sarhill N, Walsh D, Nelson KA (2001) Hydromorphone: pharmacology and clinical applications in cancer patients. Support Care Cancer 9:84–96

    Article  CAS  PubMed  Google Scholar 

  31. Pereira, J et al (2001) Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manage 22:672–687

    Article  CAS  PubMed  Google Scholar 

  32. Korte W, Stoutz N, Morant R (1996) Day-to-day titration to initiate transdermal fentanyl in cancer patients: short- and long-term experience in a prospective study of 39 patients. J Pain Symptom Manage 11:139–146

    Article  CAS  PubMed  Google Scholar 

  33. Coluzzi PH et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91:123–130

    Article  CAS  PubMed  Google Scholar 

  34. Burton AW et al (2004) Oral transmucosal fentanyl citrate in the outpatient management of severe cancer pain crises. Clin J Pain 20:195–197

    Article  PubMed  Google Scholar 

  35. Budd K (2003) Buprenorphine and the transdermal system: the ideal match in pain management. Int J Clin Pract 133:9–14

    CAS  Google Scholar 

  36. Skaer TL (2004) Practice guidelines for transdermal opioids in malignant pain. Drugs 64(23):2629–2638

    Article  CAS  PubMed  Google Scholar 

  37. Evans HC, Easthope SE (2003) Transdermal buprenotphine. Drugs 63(19):1999–2010

    Article  CAS  PubMed  Google Scholar 

  38. Heiskanen TE et al (2000) Morphine or oxycodone in cancer pain? Acta Oncologica 39:941–947

    Article  CAS  PubMed  Google Scholar 

  39. Davis MP, Walsh D (2001) Methadone for relief of cancer pain: a review of pharmacokinetics, pharmacodynamics, drug interactions and protocols of administration. Support Care Cancer 9:73–83

    Article  CAS  PubMed  Google Scholar 

  40. Berland D (2000) Pain management in patients with advanced cancer. Ann Intern Med 132:593

    CAS  PubMed  Google Scholar 

  41. Lawlor PG et al (1998) Dose ratio between morphine and methadone in patients with cancer pain: a retrospective study. Cancer 82:1167–1173

    Article  CAS  PubMed  Google Scholar 

  42. Ripamonti C et al (1998) Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? J Clin Oncol 16:3216–3221

    CAS  PubMed  Google Scholar 

  43. Kannan TR et al (2002) Oral ketamine as an adjuvant to oral morphine for neuropathic pain in cancer patients. J Pain Symptom Manage 23:60–65

    Article  CAS  PubMed  Google Scholar 

  44. Mercadante S et al (2000) Analgesic effects of intravenous ketamine in cancer patients on morphine therapy: a randomized, controlled, double-blind, crossover, double-dose study. J Pain Symptom Manage 2000(20)

    Google Scholar 

  45. Balducci L (2003) Management of cancer pain in geriatric patients. J Support Oncol 1(3):175–191

    PubMed  Google Scholar 

  46. Collins SL et al (2000) Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage 20:449–458

    Article  CAS  PubMed  Google Scholar 

  47. Onghena P, van Houdenhove B (1992) Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies. Pain 49:205–219

    Article  CAS  PubMed  Google Scholar 

  48. Watson CP (2000) The treatment of neuropathic pain: antidepressants and opioids. Clin J Pain 16(Suppl 2):49–55

    Google Scholar 

  49. Magni G, Arsie D, De Leo D (1987) Antidepressants in the treatment of cancer pain: a survey in Italy. Pain 29:347–353

    Article  CAS  PubMed  Google Scholar 

  50. Walsh TD (1986) Controlled study of imipramine and morphine in chronic pain due to advanced cancer. Proc Am Soc Clin Oncol 5:237

    Google Scholar 

  51. Glassman AH, Bigger JT (1981) Cardiovascular effects of therapeutic doses of tricyclic antidepressants. A review. Arch Gen Psychiatr 38:815–820

    CAS  PubMed  Google Scholar 

  52. Masand PS, Gupta S (1999) Selective serotonin-reuptake inhibitors: an update. Harvard Rev Psychiatr 52:547–552

    Google Scholar 

  53. Sindrup SH et al (1990) The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain 42(2):135–144

    Article  CAS  PubMed  Google Scholar 

  54. Sindrup SH et al (1992) The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. Clin Pharmacol Ther 52(5):547–552

    Article  CAS  PubMed  Google Scholar 

  55. Sindrup SH et al (2003) Venlafaxine versus imipramine in painful polyneuropathy: a randomized, controlled trial. Neurology 60(8):1284–1289

    CAS  PubMed  Google Scholar 

  56. Backonja MM (2000) Anticonvulsants (antineuropathics) for neuropathic pain syndromes. Clin J Pain 16(Suppl 6):67–72

    Google Scholar 

  57. Jensen TS (2002) Anticonvulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 6A:61–68

    Article  CAS  Google Scholar 

  58. Rice AS, Maton S (2001) Gabapentin in postherpetic neuralgia: a randomized, double blind, placebo-controlled study. Pain 94:215–224

    Article  CAS  PubMed  Google Scholar 

  59. Rowbotham M et al (1998) Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 280:1837–1842

    Article  CAS  PubMed  Google Scholar 

  60. Tremont-Lukats IW, Megeff C, Backonja MM (2000) Anticonvulsants for neuropathic pain syndromes: mechanism of action and place in therapy. Drugs 60:1029–1052

    Article  CAS  PubMed  Google Scholar 

  61. Caraceni A et al (1999) Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain. J Pain Symptom Manage 17:441–445

    Article  CAS  PubMed  Google Scholar 

  62. Oneschuk D, al-Shahri MZ (2003) The pattern of gabapentin use in a tertiary palliative care unit. J Palliat Care 195:185–187

    Google Scholar 

  63. Caraceni A et al (2004) Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin cancer pain study group. J Clin Oncol 22(14):2909–2917

    Article  CAS  PubMed  Google Scholar 

  64. Dworkin RH et al (2003) Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 60:1524–1534

    Article  PubMed  Google Scholar 

  65. Yajnik S et al (1992) Phenytoin as a coanalgesic in cancer pain. J Pain Symptom Manage 7:209–230

    Article  CAS  PubMed  Google Scholar 

  66. Vestergaard K et al (2001) Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology 56:184–190

    CAS  PubMed  Google Scholar 

  67. Zakrzewska JM et al (1997) Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain 73:223–230

    Article  CAS  PubMed  Google Scholar 

  68. Dworkin RH et al (2003) Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 60:1274–1283

    CAS  PubMed  Google Scholar 

  69. Price MJ (2004) Levetiracetam in the treatment of neuropathic pain: three case studies. Clin J Pain 20:33–36

    Article  PubMed  Google Scholar 

  70. Ettinger AB, Portenoy RK (1988) The use of corticosteroids in the treatment of symptoms associated with cancer. J Pain Symptom Manage 3:99–103

    Article  CAS  PubMed  Google Scholar 

  71. Greenberg HS, Kim JH, Posner JB (1980) Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol 8:361–366

    Article  CAS  PubMed  Google Scholar 

  72. Watanabe S, Bruera E (1994) Corticosteroids as adjuvant analgesics. J Pain Symptom Manage 9:442–445

    Article  CAS  PubMed  Google Scholar 

  73. Farr WC (1990) The use of corticosteroids for symptom management in terminally ill patients. Am J Hosp Care 7:41–46

    Article  CAS  PubMed  Google Scholar 

  74. Mercadante S, Fulfaro F, Casuccio A (2001) The use of corticosteroids in home palliative care. Support Care Cancer 9:386–389

    Article  CAS  PubMed  Google Scholar 

  75. Khojainova N et al (2002) Olanzapine in the management of cancer pain. J Pain Symptom Manage 23:346–350

    Article  CAS  PubMed  Google Scholar 

  76. Dalal S, Melzack R (1998) Potentiation of opioid analgesia by psychostimulant drugs: a review. J Pain Symptom Manage 16:245–253

    Article  CAS  PubMed  Google Scholar 

  77. Rozans M et al (2002) Palliative uses of methylphenidate in patients with cancer: a review. J Clin Oncol 20:335–339

    Article  CAS  PubMed  Google Scholar 

  78. Rosen LS et al (2001) Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial. Cancer J 7:377–387

    CAS  PubMed  Google Scholar 

  79. Serafini AN (2001) Therapy of metastatic bone pain. J Nucl Med 42:895–906

    CAS  PubMed  Google Scholar 

  80. Roth A, Kolaric K (1986) Analgesic activity of calcitonin in patients with painful osteolytic metastases of breast cancer: results of a controlled randomized study. Oncology 43:283–287

    Article  CAS  PubMed  Google Scholar 

  81. Szanto J, Ady N, Jozsef S (1992) Pain killing with calcitonin nasal spray in patients with malignant tumors. Oncology 49:180–182

    Article  CAS  PubMed  Google Scholar 

  82. Slavin KV, Tesoro EP, Mucksavage JJ (2004) The treatment of cancer pain. Drugs Today 40(3):235–245

    Article  CAS  PubMed  Google Scholar 

  83. Eisenach JC et al (1995) Epidural clonidine analgesia for intractable cancer pain. The epidural clonidine study group. Pain 61:391–399

    Article  CAS  PubMed  Google Scholar 

  84. Pud D et al (1998) The NMDA receptor antagonist amantadine reduces surgical neuropathic pain in cancer patients: a double blind, randomized, placebo-controlled trial. Pain 75:349–354

    Article  CAS  PubMed  Google Scholar 

  85. Jones B et al (2003) Is there still a role for open cordotomy in cancer pain management? J Pain Symptom Manage 25:179–184

    Article  CAS  PubMed  Google Scholar 

  86. Nauta HJ et al (2000) Punctate midline myelotomy for the relief of visceral cancer pain. J Neurosurg 92(Suppl 2):125–130

    CAS  PubMed  Google Scholar 

  87. Whittle IR, Jenkinson JL (1995) CT-guided stereotactic antero-medial pulvinotomy and centromedian-parafascicular thalamotomy for intractable malignant pain. Br J Neurosurg 9:195–200

    Article  CAS  PubMed  Google Scholar 

  88. Wong ET et al (1997) Palliation of intractable cancer pain by MRI-guided cingulotomy. Clin J Pain 13:260–263

    Article  CAS  PubMed  Google Scholar 

  89. Kanpolat Y et al (1995) CT-guided pain procedures for intractable pain in malignancy. Acta Neurochir Suppl (Wien) 64:88–91

    CAS  Google Scholar 

  90. Taub E (2003) Spinal cord stimulation for cancer-related pain: a neglected indication? Quadrennial Meeting Am Soc Stereotactic Funct Neurosurg, New York (May 18–21). p 52

    Google Scholar 

  91. Rauck RL et al (2003) Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. J Pain Symptom Manage 4(8):441–447

    CAS  Google Scholar 

  92. Smith TJ et al (2002) Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 20:4040–4049

    Article  CAS  PubMed  Google Scholar 

  93. Slavin KV, Hsu FPK, Fessler RG (2002) Intrathecal opioids: intrathecal drug-delivery systems. In: Burchiel KJ (eds) Surgical management of pain. Thieme, New York, pp 603–613

    Google Scholar 

  94. Dews TE, Mekhail N (2004) Safe use of opioids in chronic noncancer pain. Cleve Clin J Med 71(11):897–904

    Article  PubMed  Google Scholar 

  95. Becker R et al (2000) The significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions. Stereotact Funct Neurosurg 75:16–26

    Article  CAS  PubMed  Google Scholar 

  96. McGivern JG, McDonough SI (2004) Voltage-gated calcium channels as targets for the treatment of chronic pain. Curr Drug Targets CNS Neurol Disord 3(6):457–478

    Article  CAS  PubMed  Google Scholar 

  97. Miljanich GP, Ramachandran J (1995) Antagonists of neuronal calcium channels: structure, function, and therapeutic implications. Annu Rev Pharmacol Toxicol 35:707–734

    Article  CAS  PubMed  Google Scholar 

  98. Miljanich GP (2004) Ziconotide: neuronal calcium channel blocker for treating severe chronic pain. Curr Med Chem 11(23):3029–3040

    CAS  PubMed  Google Scholar 

  99. Mathur V (2000) Ziconotide: a new pharmacological class of drug for the management of pain. Semin Anesth Periop Med Pain 19:67–75

    Article  CAS  Google Scholar 

  100. Staats PS et al (2004) Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS. JAMA 291:63–70

    Article  CAS  PubMed  Google Scholar 

  101. Doggrell SA (2004) Intrathecal ziconotide for refractory pain. Expert Opin Investig Drugs 13(7):875–877

    Article  CAS  PubMed  Google Scholar 

  102. Webster L et al (2001) (233) characterization of confusion, an adverse event associated with intrathecal ziconotide infusion in chronic pain patients. Pain Med 2(3):253–254

    Article  Google Scholar 

  103. Wermeling D et al (2003) Pharmacokinetics and pharmacodynamics of intrathecal ziconotide in chronic pain patients. J Clin Pharmacol 43(6):624–636

    CAS  PubMed  Google Scholar 

  104. Slavin KV, Solko AM (2003) Intrathecal narcotics: spinal and intraventricular. In: Schulder M (eds) Handbook of stereotactic and functional neurosurgery. Marcel Dekker, New York, pp 443–457

    Google Scholar 

  105. Meldrum M (2005) The ladder and the clock: cancer pain and public policy at the end of the twentieth century. J Pain Symptom Manage 29:41–54

    Article  PubMed  Google Scholar 

  106. Ahmedzai S (1997) New approaches to pain control in patients with cancer. Eur J Can 33(Suppl 6):S8–S14

    Article  CAS  Google Scholar 

  107. Slavin KV, Laurito C (2003) Surgical approaches to cancer pain: experience of single institution. J Pain 4(Suppl 1):90

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hrachya Nersesyan .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Nersesyan, H., Mucksavage, J.J., Tesoro, E., Slavin, K.V. (2011). Pain Management in Cancer Patients. In: Minev, B. (eds) Cancer Management in Man: Chemotherapy, Biological Therapy, Hyperthermia and Supporting Measures. Cancer Growth and Progression, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-9704-0_24

Download citation

  • DOI: https://doi.org/10.1007/978-90-481-9704-0_24

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-9703-3

  • Online ISBN: 978-90-481-9704-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics