Faculty Opinions recommendation of My patient with rectal cancer does not have pain control despite high doses of opioids and optimal doses of gabapentin and desipramine. Now what?–Advanced strategies for cancer pain management.

Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.

Download Full-text

Cancer pain management in Mexico

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001871 ◽

2019 ◽

pp. bmjspcare-2019-001871

Author(s):

Sarah Barry Lincoln ◽

Enrique Soto-Perez-de-Celis ◽

Yanin Chavarri-Guerra ◽

Alfredo Covarrubias-Gomez ◽

Mariana Navarro ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Latin American ◽

Low Income ◽

Pain Control ◽

Current Status ◽

Cancer Pain Management ◽

Middle Income ◽

Care Training

BackgroundPain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack of access to opioid analgesics to alleviate pain from various conditions such as cancer.ObjectivesWe aimed to review the history and current status of cancer pain management in Mexico, a middle-income Latin American country. Our objective was to identify existing barriers to proper, effective opioid use, as well as provide practical recommendations for improvement.MethodsUsing a search of EBSCOhost database, PubMed and Google, we found official documents and peer-reviewed articles related to health legislation, opioid consumption, palliative care infrastructure and palliative care training in Mexico.ResultsDespite advances in palliative care and access to opioids in Mexico, there are still several barriers that undermine effective pain management, showing a major gap between policy and practice. Although Mexican legislation and guidelines include adequate palliative care and pain control as a right for all patients with cancer, the lack of adequate infrastructure and trained personnel severely hampers the implementation of these policies. Additionally, there are important barriers to prescribing opioids, many of which are related to attempts at reducing the consumption of recreational drugs.ConclusionsAlthough Mexico has made significant improvements in pain control and palliative care, much needs to be done. Expansion of drug availability, improvement of palliative care training, and constant oversight of regulations and guidelines will help to strengthen Mexico’s palliative care services.

Download Full-text

Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2007.0075 ◽

2007 ◽

Vol 5 (8) ◽

pp. 851-858 ◽

Cited By ~ 12

Author(s):

Anthony Eidelman ◽

Traci White ◽

Robert A. Swarm

Keyword(s):

Pain Management ◽

Adverse Effects ◽

Cancer Pain ◽

Pain Control ◽

Analgesic Efficacy ◽

Cancer Pain Management ◽

Patients With Cancer ◽

Inflammatory Drugs ◽

Control Pain ◽

Interventional Therapies

Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.

Download Full-text