scholarly journals Analgesic Effect of a 5% Lidocaine Patch in Patients With Opioid Treatment-Resistant Neuropathic Cancer Pain

2021 ◽  
Author(s):  
Jui-hung Tsai ◽  
I-Ting Liu ◽  
Pei-Fang Su ◽  
Ying-Tzu Huang ◽  
Ge-Lin Chiu ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Transdermal Patch ◽  
Analgesic Treatment ◽  
Opioid Treatment ◽  
Significant Difference

Abstract PurposeLimited efficacy has been observed when using morphine to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in post-herpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to demonstrate a useful treatment for cancer-related neuropathic pain. The primary endpoint was pain intensity evaluated by the visual analog scale (VAS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. MethodsWe assessed the efficacy and safety of lidocaine patches in patients experiencing neuropathic cancer pain. Terminal cancer patients with opioid treatment resistance participated in the 3-day study. ResultsThe results showed a statistically significant difference in the median VAS over three days (Kruskal-Wallis test, P<0.0001). The median VAS pain intensity from Day 1 to Day 3 was 4.0 with 95% C.I. (3.3, 5.0), 3.0 (2.5, 3.5) and 2.5 (2.0, 3.0), respectively. The difference between the median VAS pain intensities of any two days was statistically significant (Wilcoxon signed-rank test, P < 0.0001). There was no statistically significant difference in the pain relief score or the quality of analgesic treatment. ConclusionIn this study, the 5% lidocaine transdermal patch reduced the VAS pain intensity in neuropathic cancer patients with morphine resistance. The transdermal patch is generally useful and well-tolerated.

scholarly journals A Prospective Multicentre Study to Evaluate the Efficacy and Tolerability of Osmotic Release Oral System (Oros®) Hydromorphone in Opioid-Naive Cancer Patients: Results of the Korean South West Oncology Group Study

2015 ◽  
Vol 20 (6) ◽  
pp. 293-299 ◽  
Author(s):  
Eun-Kee Song ◽  
Hyunjeong Shim ◽  
Hye-Suk Han ◽  
DerSheng Sun ◽  
Soon-Il Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Pain Control ◽  
Intensity Difference ◽  
Front Line ◽  
Long Acting

BACKGROUND: Osmotic release oral system (OROS®) hydromorphone is a potent, long-acting opioid analgesic, effective and safe for controlling cancer pain in patients who have received other strong opioids. To date, few studies have examined the efficacy of hydromorphone for pain relief in opioid-naive cancer patients.OBJECTIVES: A prospective, open-label, multicentre trial was conducted to determine the efficacy and tolerability of OROS hydromorphone as a single and front-line opioid therapy for patients experiencing moderate to severe cancer pain.METHODS: OROS hydromorphone was administered to patients who had not previously received strong, long-acting opioids. The baseline evaluation (visit 1) was followed by two evaluations (visits 2 and 3) performed two and 14 weeks later, respectively. The starting dose of OROS hydromorphone was 4 mg/day and was increased every two days when pain control was insufficient. Immediate-release hydromorphone was the only accepted alternative strong opioid for relief of breakthrough pain. The efficacy, safety and tolerability of OROS hydromorphone, including the effects on quality of life, and patients’ and investigators’ global impressions on pain relief were evaluated. The primary end point was pain intensity difference (PID) at visit 2 relative to visit 1 (expressed as %PID).RESULTS: A total of 107 patients were enrolled in the present study. An improvement in pain intensity of >50% (≥50% PID) was observed in 51.0% of the full analysis set and 58.6% of the per-protocol set. The mean pain score, measured using a numerical rating scale, was significantly reduced after two weeks of treatment, and most adverse events were manageable. Quality of life also improved, and >70% of patients and investigators were satisfied with the treatment.CONCLUSIONS: OROS hydromorphone provided effective pain relief and improved quality of life in opioid-naive cancer patients. As a single and front-line treatment, OROS hydromorphone delivered rapid pain control.

Amitriptyline in Neuropathic Cancer Pain in Patients on Morphine Therapy: A Randomized Placebo-controlled, Double-blind Crossover Study

2002 ◽  
Vol 88 (3) ◽  
pp. 239-242 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Edoardo Arcuri ◽  
Walter Tirelli ◽  
Patrizia Villari ◽  
Alessandra Casuccio
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Double Blind ◽  
Blind Crossover Study ◽  
Double Blind Crossover Study

Aims and Background Amitriptyline is the most common analgesic adjuvant used in cancer patients with neuropathic pain, even though no specific studies have demonstrated a benefit. A randomized placebo-controlled, double-blind crossover study was designed to evidence the effects of amitriptyline in patients with neuropathic cancer pain. Methods Sixteen advanced cancer patients with neuropathic pain on systemic morphine therapy, no longer receiving oncologic treatment, presenting moderate pain (about 4 or more, but less than 7, on a numerical scale of 0-10) in the last week, and given a stable morphine dose in the last 2 days were admitted to the study. During the first week of study, patients were administered 25 mg of amitriptyline or equivalent drops of placebo at night for 3 days and 50 mg for the following 4 days. Doses for patients aged more than 65 years were 15 mg (first 3 days) and 30 mg (3 days after). After a week, a crossover took place for the second week, with the other treatment at an inverse sequence. Opioid consumption, pain intensity, symptoms and adverse effects, mood, sleep, patient's preference, quality of life before starting the study, the first week after and the second week after were recorded. Results No significant benefits in analgesia were found in the global pain intensity of the previous week of treatment, the least pain intensity or the pain evaluated just after a week of treatment, at the moment of the visit, when amitriptyline was compared with placebo. A significant difference was evidenced for the worst pain (P < 0.035). No differences in opioid doses during the period of study were found. Drowsiness, confusion and dry mouth were significantly more intense with amitriptyline than with placebo (P < 0.036, 0.003, and 0.034, respectively). There were no substantial differences between the two treatments in Spitzer's quality of life score and for each item. No differences in patients' preference for the two treatment periods were found. The analgesic effects of amitriptyline were slight and associated with adverse effects. Conclusions In light of the results obtained in the study, the extensive use of the drug for cancer pain should be questioned.

scholarly journals A Prospective, Multicenter, Open-Label Study of The Clinical Efficacy of Tapentadol Extended-Release in The Treatment of Cancer-Related Pain and Improvement of Quality of Life in Opioid-Naïve or Opioid-Resistant Patients

2021 ◽  
Author(s):  
Jiyoon Jung ◽  
Hong Jae Chon ◽  
YoungJin Choi ◽  
SangEun Yeon ◽  
SeokYoung Choi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Extended Release ◽  
Drug Reactions ◽  
Open Label ◽  
Observation Period

Abstract Purpose: This study was to investigate the clinical efficacy of tapentadol extended-release (ER) on pain control and the quality of life of patients with moderate to severe chronic cancer pain in clinical practice in Korea.Methods: In this prospective, open-label, multicenter trial, patients with sustained cancer pain as well as chronic pain, using or not using other analgesics were enrolled. Thirteen centers recorded a total of 752 patients, during the 6-month observation period, based on the tapentadol ER dose and tolerability, prior and concomitant analgesic treatment, pain intensity, type of pain, adverse effects, and clinical global impression change (CGI-C). A total of 752 patients were screened, 688 were enrolled, and 650 completed the study for efficacy and adverse drug reactions; among them 349 were cancer patients.Results: In total, 752 patients were screened, 688 were enrolled and 650 were completed the study for efficacy and adverse drug reactions, 349 of whom were cancer patients. Tapentadol ER significantly reduced the mean pain intensity including neuropathic pain during the observation period by 2.9 points (from a mean 7±0.87 to 4.1±2.02). Furthermore, the quality of life was observed to be significantly improved based on an objective observation, such as the CGI-C.Conclusion: This study showed that tapentadol ER was effective in patients with moderate to severe cancer pain and was also effective in neuropathic pain, and therefore it significantly improved the patients’ quality of life.

Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial

2003 ◽  
Vol 21 (22) ◽  
pp. 4120-4126 ◽  
Author(s):  
David Alimi ◽  
Carole Rubino ◽  
Evelyne Pichard-Léandri ◽  
Sabine Fermand-Brulé ◽  
Marie-Laure Dubreuil-Lemaire ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Controlled Trial ◽  
Auricular Acupuncture ◽  
Analgesic Treatment ◽  
Analgesic Drugs ◽  
The Difference ◽  
Absolute Decrease ◽  
Therapy Treatment

Purpose: During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients.Patients and Methods: Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS.Results: The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P < .0001).Conclusion: The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment.

Pulsed radiofrequency in peripheral posttraumatic neuropathic pain: A double blind sham controlled randomized clinical trial

2012 ◽  
Vol 3 (3) ◽  
pp. 127-131 ◽  
Author(s):  
Ethem Akural ◽  
Voitto Järvimäki ◽  
Raija Korhonen ◽  
Hannu Kautiainen ◽  
Maija Haanpää
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Adverse Effects ◽  
Pain Intensity ◽  
Pain Intensity Score ◽  
Pulsed Radiofrequency ◽  
Double Blind ◽  
Sham Treatment ◽  
Sf 36 ◽  
Significant Difference

AbstractBackground and purposePulsed radiofrequency (PRF) is widely used for the treatment of chronic pain, although its mechanism of action is not known. The evidence of efficacy of PRF for neuropathic pain (NP) conditions is limited. A double-blind, randomized, sham-controlled parallel study was conducted to evaluate the efficacy and safety of PRF in the treatment of peripheral posttraumatic NP.MethodsForty-five patients with peripheral posttraumatic NP in their upper or lower limb were randomly assigned to receive PRF or sham treatment to the injured peripheral nerve (s) causing peripheral posttraumatic NP. Only patients whose pain intensity was at least 5 on numerical rating scale (NRS) 0–10 and who had suffered from their NP for at least 6 months were included. All patients had dynamic mechanical allodynia or pinprick hyperalgesia in their painful area. They had achieved temporary pain relief of at least 50% with a local nerve block performed at a previous visit. The primary efficacy variable was the difference in 3-day mean pain intensity score from the baseline to 3 months. Other variables included response defined as ≥30% reduction in mean pain intensity at 3 months compared to baseline, Neuropathic Pain Scale (NPS) results, health related quality of life (SF-36) and adverse effects. The skin was anesthetized with 1% lidocaine. A radiofrequency needle was introduced through the skin, and then guided to a SMK cannula (52, 100 or 144mm depending on the target nerve) with 4 or 5mm active tip (SMK-C5-4, SMK-C10-5, SMK-C15-5, Radionics®, Burlington, MA, USA). The nerve was located accurately by stimulating at 50 Hz (threshold <0.5 V). Sham treatment or PRF was applied for 120s 1–4 times at each treatment point (Radionics®, Burlington, MA, USA). The total treatment time was up to 8 min. Both patients and clinicians were blinded during the whole treatment and follow-up period.ResultsForty-three patients were included in the analyses. There was no statistically significant difference between PRF and sham treatment for the primary outcome efficacy variable.Seven patients (3 in PRF group and 4 in sham treatment group) achieved ≥30% pain relief (difference between groups was not significant). There was no statistically significant difference in the NPS or any dimension of SF-36 between the treatments. Eighteen patients reported adverse effects. They were mild and did not necessitate any treatment. Transient pain was reported by 17 patients, local irritation by 5 patients and local inflammation by 1 patient. There was no significant difference between the groups in the presence of adverse effects.ConclusionsPRF was well tolerated, but this study failed to show efficacy of PRF over sham treatment for peripheral posttraumatic NP.ImplicationsBased on our results, we do not recommend PRF for peripheral posttraumatic NP. More research of the possible use of PRF for various pain conditions is needed to determine its role in the management of prolonged pains.

Efficacy and tolerability of fentanyl buccal tablet (FBT) in opioid-tolerant cancer patients with neuropathic pain

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19549-19549
Author(s):  
R. Thakur ◽  
J. A. Vaughan ◽  
J. Messina ◽  
F. Xie ◽  
D. R. Taylor
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Significant Proportion ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Fentanyl Buccal Tablet ◽  
Buccal Tablet ◽  
Efficacy Measures

19549 Background: Fentanyl buccal tablet (FBT), a new formulation recently approved by the FDA for opioid-tolerant patients with cancer-related breakthrough pain (BTP), provides rapid-onset analgesia. Neuropathic pain is the primary pain pathophysiology in a significant proportion of patients with chronic cancer pain; therefore, the efficacy and safety of FBT was studied in this subpopulation. Methods: The efficacy and safety of FBT in the treatment of BTP in opioid-tolerant cancer patients with neuropathic pain were evaluated as a sub-analysis of two randomized, double-blind, placebo-controlled studies. Of the 45 patients in the sub-analysis (50% male, 86% white, mean age 56 years), 30 identified an effective FBT dose during open-label titration and were randomly assigned to double-blind crossover dose sequences of 10 tablets (7 FBT, 3 placebo). Pain intensity (PI) and pain relief (PR) were recorded at intervals after dosing. The primary efficacy measures were the sum of pain intensity differences (PIDs) for the first 30 (SPID30) and 60 minutes (SPID60); secondary efficacy measures included PIDs, PR, and total pain relief (TOTPAR). Use of supplemental BTP medication and adverse events (AEs) were recorded. Results: Combined data (all values mean ±SD) favored FBT vs placebo for SPID30 (3.35±3.11 vs 1.88±2.58) and were significant for SPID60 (9.90±7.19 vs 5.51±6.06; 95% CI, 2.99, 5.81). There was a greater reduction in PI following FBT vs placebo at 10 minutes (PID, 0.55±0.89 vs 0.24±0.48), which continued through observation periods of up to 2 hours (3.43±2.44 vs 1.95±1.99). Higher PR scores were noted following FBT vs placebo at 10 minutes (0.43±0.39 vs 0.21±0.28), which continued for up to 2 hours (1.99±0.72 vs 1.36±0.60). TOTPAR was better following FBT vs placebo at 15 (0.88±0.89 vs 0.48±0.73), 30 (2.42±1.85 vs 1.40±1.65), 45 (4.29±2.90 vs 2.61±2.68), and 60 minutes (6.34±4.02 vs 3.94±3.81). Patients were more than twice as likely to require supplemental opioids for BTP episodes following placebo vs FBT. AEs were typical for opioids; e.g., headache (23%), nausea (18%), dizziness (18%), vomiting (14%), and fatigue (11%). Conclusions: FBT was effective and well tolerated in a subgroup of cancer patients with BTP in association with chronic neuropathic pain. No significant financial relationships to disclose.

scholarly journals Patient and Physician Satisfaction with Analgesic Treatment: Findings from the Analgesic Treatment for Cancer Pain in Southeast Asia (ACE) Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Dang Huy Quoc Thinh ◽  
Wimonrat Sriraj ◽  
Marzida Mansor ◽  
Kian Hian Tan ◽  
Cosphiadi Irawan ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Intensity ◽  
Pain Control ◽  
Weighted Kappa ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Analgesic Treatment ◽  
Ace Study ◽  
Pain Patients

Aim. The aim of this study was to examine patients’ and physicians’ satisfaction, and concordance of patient-physician satisfaction with patients’ pain control status. Methods. This cross-sectional observational study involved 465 adults prescribed analgesics for cancer-related pain from 22 sites across Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Pain intensity, pain control satisfaction, and adequacy of analgesics for pain control were documented using questionnaires. Results. Most patients (84.4%) had stage III or IV cancer. On a scale of 0 (no pain) to 10 (worse pain), patients’ mean worst pain intensity over 24 hours was 4.76 (SD 2.47). More physicians (19.0%) than patients (8.0%) reported dissatisfaction with patient’s pain control. Concordance of patient-physician satisfaction was low (weighted kappa 0.36; 95% CI 0.03–0.24). Most physicians (71.2%) found analgesics to be adequate for pain control. Patients’ and physicians’ satisfaction with pain control and physician-assessed analgesic adequacy were significantly different across countries (P<0.001 for all). Conclusions. Despite pain-related problems with sleep and quality of life, patients were generally satisfied with their pain control status. Interestingly, physicians were more likely to be dissatisfied with patients’ pain control. Enhanced patient-physician communication, physicians’ proactivity in managing opioid-induced adverse effects, and accessibility of analgesics have been identified to be crucial for successful cancer pain management. This study was registered at ClinicalTrials.gov (identifier NCT02664987).

scholarly journals Ketamine and Magnesium for Refractory Neuropathic Pain

2020 ◽  
Vol 133 (1) ◽  
pp. 154-164 ◽  
Author(s):  
Gisèle Pickering ◽  
Bruno Pereira ◽  
Véronique Morel ◽  
Alexandrine Corriger ◽  
Fatiha Giron ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Pain Intensity ◽  
Analgesic Effect ◽  
Area Under The Curve ◽  
Controlled Study ◽  
Double Blind ◽  
Daily Pain

Background Ketamine is often used for the management of refractory chronic pain. There is, however, a paucity of trials exploring its analgesic effect several weeks after intravenous administration or in association with magnesium. The authors hypothesized that ketamine in neuropathic pain may provide pain relief and cognitive–emotional benefit versus placebo and that a combination with magnesium may have an additive effect for 5 weeks. Methods A randomized, double-blind, crossover, placebo-controlled study (NCT02467517) included 20 patients with neuropathic pain. Each ketamine-naïve patient received one infusion every 35 days in a random order: ketamine (0.5 mg/kg)/placebo or ketamine (0.5 mg/kg)/magnesium sulfate (3g) or placebo/placebo. The primary endpoint was the area under the curve of daily pain intensity for a period of 35 days after infusion. Secondary endpoints included pain (at 7, 15, 21 and 28 days) and health-related, emotional, sleep, and quality of life questionnaires. Results Daily pain intensity was not significantly different between the three groups (n = 20) over 35 days (mean area under the curve = 185 ± 100, 196 ± 92, and 187 ± 90 pain score-days for ketamine, ketamine/magnesium, and placebo, respectively, P = 0.296). The effect size of the main endpoint was −0.2 (95% CI [−0.6 to 0.3]; P = 0.425) for ketamine versus placebo, 0.2 (95% CI [−0.3 to 0.6]; P = 0.445) for placebo versus ketamine/magnesium and -0.4 (95% CI [−0.8 to 0.1]; P = 0.119) for ketamine versus ketamine/magnesium. There were no significant differences in emotional, sleep, and quality of life measures. During placebo, ketamine, and ketamine/magnesium infusions, 10%, 20%, and 35% of patients respectively reported at least one adverse event. Conclusions The results of this trial in neuropathic pain refuted the hypothesis that ketamine provided pain relief at 5 weeks and cognitive–emotional benefit versus placebo and that a combination with magnesium had any additional analgesic effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Osteopathic Manipulative Treatment Effect on Pain Relief and Quality of Life in Oncology Geriatric Patients: A Nonrandomized Controlled Clinical Trial

2018 ◽  
Vol 17 (4) ◽  
pp. 1163-1171 ◽  
Author(s):  
Chiara Arienti ◽  
Teresa Bosisio ◽  
Silvia Ratti ◽  
Rossella Miglioli ◽  
Stefano Negrini
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Pain Relief ◽  
Pain Intensity ◽  
Geriatric Patients ◽  
Controlled Clinical Trial ◽  
Osteopathic Manipulative Treatment ◽  
Oncology Patients ◽  
Significant Difference

Purpose: The aim of present study was to study the effect of osteopathic manipulation on pain relief and quality of life improvement in hospitalized oncology geriatric patients. Methods: A nonrandomized controlled clinical trial was performed in the Oncology Rehabilitation Unit, Milan, Italy, from September 2015 to March 2016. Twenty-three older cancer patients were enrolled and allocated in 2 experimental groups: the study group (OMT group, N = 12) underwent osteopathic manipulative treatment in addition to physiotherapy, and the control group (PT group, N = 12) underwent only physiotherapy. At enrollment (T0), 24 recruited oncology patients completed the sociodemographic forms and were evaluated for pain intensity and quality of life by an external examiner. All patients were revaluated every week (T1, T2, T3, and T4) for pain intensity and at the end of the study treatment (T4) for quality of life. A standard level of significance was set at α < .05. Results: The 2 groups did not significantly differ in age ( P = .682), body mass index ( P = .413), or gender ( P = 1). The osteopathic manipulative treatment added to physiotherapy produced a significant reduction in Numeric Rating Scale (NRS) scores both at T2 ( P = .004) and T4 ( P = .002). The difference in quality of life improvements between T0 and T4 was not statistically significant. NRS improved in the PT group at T4. Between-group analysis of NRS and quality of life with the Mann-Whitney test did not show any significant difference between the 2 treatments. Conclusions: Our study showed a significant improvement in pain relief and a nonsignificant improvement in quality of life in hospitalized geriatric oncology patients during osteopathic manipulative treatment. Trial Registration: Protocol registered on Clinicaltrials.gov (NCT03142386).

Cancer pain management

2014 ◽  
Vol 155 (3) ◽  
pp. 93-99
Author(s):  
Péter Heigl
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Relief ◽  
Life Expectancy ◽  
Cancer Pain ◽  
Cancer Pain Management ◽  
Medical Activity ◽  
Short Summary ◽  
Adequate Quality

Pain is a significant and alarming symptom of cancer seriously affecting the activity and quality of life of patients. Recent research proved that inadequate analgesia shortens life expectancy. Therefore, pain relief is not only a possibility but a professional, ethical and moral commitment to relieve patients from suffering, as well as ensure their adequate quality of life and human dignity. Proper pain relief can be achieved with medical therapy in most of the cases and the pharmacological alternatives are available in Hungary. Yet medical activity regarding pain relief is far from the desired. This paper gives a short summary of the guidelines on medical pain management focusing particularly on the use of opioids. Orv. Hetil., 2014, 155(3), 93–99.

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