How Do Hospital Palliative Care Teams Use the WHO Guidelines to Manage Unrelieved Cancer Pain? A 1-Year, Multicenter Audit in Japan

It has been reported that pain relief for patients with cancer is suboptimal in Japan. This has been mainly attributed to inadequate dissemination of the World Health Organization (WHO) guidelines for cancer pain management. To better understand this problem, we reviewed how 6 hospital palliative care teams (HPCTs) used the WHO guidelines for unrelieved pain in a 1-year audit that included 534 patients. The HPCT interventions were classified according to the contents of the WHO guidelines. In our study, HPCT interventions involved opioid prescriptions in >80% of referred patients, and “For the Individual” and “Attention to Detail” were the 2 most important principles. Our study indicates which parts of the WHO guidelines should be most heavily emphasized, when disseminating them in Japan.

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Cancer pain management at a tertiary care cancer center in India—A retrospective analysis of 3,238 patients

Journal of Opioid Management ◽

10.5055/jom.2008.0040 ◽

2018 ◽

Vol 4 (6) ◽

pp. 361 ◽

Cited By ~ 2

Author(s):

Sushma Bhatnagar, MD ◽

Seema Mishra, MD ◽

Madhurima Srikanti, MD ◽

Deepak Gupta, MD

Keyword(s):

Cancer Pain ◽

Tertiary Care ◽

World Health ◽

Cancer Center ◽

Intractable Pain ◽

Patients With Cancer ◽

Analgesic Regimen ◽

Good Pain Relief ◽

Health Organization

Effective pain control is essential for the management of patients with cancer. About 70-80 percent of patients with cancer present in an advanced stage of disease. Patients with advanced cancer frequently experience intractable pain, with diverse symptoms that can make daily living impossible and affect the quality of life. This article reports the management of 3,238 patients with cancer pain over a period of five years. Nearly 89.6 percent patients had good pain relief, with Visual Analogue Scale score less than 3. These promising results were achieved by careful patient assessment, close liaison with clinicians from other specialties, and using a variety of analgesic regimen including oral analgesics, anesthetic procedures, psychological interventions, and supportive care. However, the main stay of treatment was oral analgesics, following the principles of World Health Organization ladder, with continuing follow-up.

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Managing Cancer Pain - Simple Rules, Major Benefits

Pain Research and Management ◽

10.1155/2004/979013 ◽

2004 ◽

Vol 9 (4) ◽

pp. 180-180

Author(s):

Dwight E Moulin

Keyword(s):

Cancer Pain ◽

Opioid Analgesic ◽

Good News ◽

World Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Cancer ◽

Health Organization ◽

A Minor ◽

Developed World

In the developed world, approximately one in three individuals will be diagnosed with cancer and one-half of those will die of progressive disease (1). At least 75% of patients with cancer develop pain before death. It is therefore not surprising that pain is one of the most feared consequences of cancer for both patients and families (2). The good news is that cancer pain can be controlled with relatively simple means in more than 80% of cases based on guidelines from the World Health Organization (3). Mild pain can be treated with acetaminophen or nonsteroidal anti-inflammatory drugs (Step 1 of the analgesic ladder). Moderate pain requires the addition of a 'minor' opioid such as codeine (Step 2), and severe pain mandates the use of a major opioid analgesic such as morphine (Step 3). In this issue of Pain Research & Management, Gallagher et al (pages 188-194) highlight some of the barriers to adequate cancer pain management based on a cross-sectional survey of British Columbian physicians. The survey response rate of 69% attests to the validity of their findings.

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Independent Research on Cancer Pain Management in the Setting of Early Palliative Care: A Flywheel to Counteract General Opioid Misuse and Abuse

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197097 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7097

Author(s):

Elena Bandieri ◽

Leonardo Potenza ◽

Fabio Efficace ◽

Eduardo Bruera ◽

Mario Luppi

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

World Health ◽

Evidence Based ◽

Cancer Pain Management ◽

Who Analgesic Ladder ◽

Early Palliative Care ◽

Positive Effects ◽

Analgesic Ladder

The increased recognition of the high prevalence and important burden of cancer pain and the documentation of a large proportion of patients receiving inadequate analgesic treatment should have reinforced the need for evidence-based recommendations. The World health Organization (WHO) guidelines on cancer pain management—or palliative care—are traditionally based on a sequential, three-step, analgesic ladder according to pain intensity: nonopioids (paracetamol or nonsteroidal anti-inflammatory drugs) to mild pain in step I; weak opioids (eg, codeine or tramadol) to mild-moderate pain in step II; and strong opioids to moderate-severe pain in step. III. Despite the widespread use of this ladder, unrelieved pain continues to be a substantial concern in one third of patients with either solid or hematologic malignancies. The sequential WHO analgesic ladder, and in particular, the usefulness of step II opioids have been questioned but there are no universally used guidelines for the treatment of pain in patients with advanced cancer and not all guideline recommendations are evidence-based. The American Society of Clinical Oncology and the European Society of Medical Oncology have recommended the implementation of early palliative care (EPC), which is a novel model of care, consisting of delivering dedicated palliative service concurrent with active treatment as early as possible in the cancer disease trajectory. Improvement in cancer pain management is one of the several important positive effects following EPC interventions. Independent well-designed research studies on pharmacological interventions on cancer pain, especially in the EPC setting are warranted and may contribute to spur research initiatives to investigate the poorly addressed issues of pain management in non cancer patients.

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Tramadol: Does it have a role in cancer pain management?

Journal of Opioid Management ◽

10.5055/jom.2005.0032 ◽

2005 ◽

Vol 1 (3) ◽

pp. 131 ◽

Cited By ~ 9

Author(s):

Eric E. Prommer, MD

Keyword(s):

Neuropathic Pain ◽

Adverse Effects ◽

Cancer Pain ◽

Drug Interactions ◽

Low Dose ◽

World Health ◽

Cancer Pain Management ◽

Patients With Cancer ◽

The World ◽

Dual Mechanism

Tramadol (Ultram, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) is considered a Step 2 analgesic under the World Health Organization’s guidelines for the treatment of patients with cancer pain. It is a centrally acting analgesic that has affinity for opioid receptors and influences the action of norepinephrine and serotonin at the synapse. This dual mechanism of analgesia makes it unique among Step 2 agents. It is metabolized by CYP2D6, which increases the potential for drug interactions. Unlike other opioids, it does not cause respiratory depression. Tramadol has been studied in cancer pain and neuropathic pain. It compares well with low-dose morphine as an analgesic. The purpose of this review is to critically examine the pharmacodynamics, pharmacology, drug interactions, and adverse effects of the drug, and, based on the data presented, discuss the drug’s role in cancer care.

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