Recent trends in pharmacologic treatment of cancer pain

Keun-Sook Sohn; Jae-Hwan Kim

doi:10.5124/jkma.2012.55.7.666

J Korean Med Assoc > Volume 55(7); 2012 > Article

Sohn and Kim: Recent trends in pharmacologic treatment of cancer pain

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(7): 666-675.

Published online: July 11, 2012

DOI: http://dx.doi.org/10.5124/jkma.2012.55.7.666

Recent trends in pharmacologic treatment of cancer pain

Keun-Sook Sohn, MD, Jae-Hwan Kim, MD

Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Jae-Hwan Kim, anejhkim@korea.ac.kr

Received June 15, 2012 Accepted June 28, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cancer pain is among the most undesirable side effects and complications for cancer patients. Severe cancer pain acts as physical and psychological stress and makes it difficult for patients to perform daily activities. Uncontrolled cancer pain can be emotionally devastating to patients. However, cancer pain can be controlled with pharmacologic treatment. Traditionally, cancer pain was treated according to the WHO three-step analgesic ladder based on the severity of pain. Recently, it has become to administer weak opioids as well as non-opioid analgesics to patients with mild pain. For moderate pain, weak opioids or strong opioids can be used. Non-opioid analgesics and adjuvant analgesics can be used as an adjuvant to opioids for all severities of cancer pain. Effective cancer pain management depends on the proper selection of a drug, dose, and route and depends on treatment of common side effects associated with the medication. The usage of medication should be individualized to each patient. If necessary, we may use other modalities such as radiotherapy, nerve block, and non-pharmacologic interventions for cancer pain control. The goal of treatment of cancer pain is to obtain complete or partial pain relief with tolerable side effects of the medication, and ultimately, to improve the quality of life of cancer patients.

Neoplasms; Pain; Drug therapy

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Figure 1

Managenent of cancer pain with opioid analgesics. IV, intravenous. ^*If there is no response after 2-3 cycles, reassess the pain (e.g., neuropathic pain) and consider the use of adjuvant analgesics and pain specialty consultation.

From Ministry of Health & Welfare. Cancer pain management guideline. Seoul: Ministry of Health & Welfare; 2012 [1] and National Comprehensive Cancer Network. NCCN clinical practice guideline in oncology: adult cancer pain. Vol. 1. Fort Washington: National Comprehensive Cancer Network; 2012 [4].

Figure 2

Example of titration of total daily dose of morphine. From Ministry of Health & Welfare. Cancer pain management guideline. Seoul: Ministry of Health & Welfare; 2012 [1].